"Healthy" Holidays

For those of us recovering from eating disorders, and, certainly, for those who've yet to start, holidays are like sweets-spitting dragons to be battled back, if not finally slain. It's primarily the Big Two that give us trouble - Thanksgiving and Christmas, or another holiday around the same time of year. In late November, tables shakily support the rewards of our self-congratulatory thanks, and, throughout much of December, they groan, Samson-like, beneath the weight of good cheer. These are occasions celebrated less with food than with FOOOOOD. The "overeater" and undereater alike struggle, but struggle in different ways.

It's a shame, really. Holidays tend to be built around the idea of friendship, family, and community. And friends, family, and communities like to eat. Food and drink are very basic, shareable resources (though, unfortunately, not always shared), and, sometimes, food and drink alone are enough to put people in a room together. My parents, still freshly divorced, now interact only on special occasions, and, while it's not just because of the food, the food helps. Their first real, extended post-divorcealyptic meeting came while visiting their anorexic son (that's me) at an eating disorder center. It was oddly fun.

On Thanksgiving, I didn't do so well. I went, along with the rest of the family, to my sister's; but I ate only a slight piece of the nutty coffee cake I purchased at the last minute, and I counted that as a supplement toward my meal plan. But I also took home some turkey (one of my "safe" foods), and, using it and other items, I ultimately met my meal plan for the day. Yet, it was and is clear that, despite my greater health, I still struggle. Not just with the food itself, but with the time of day at which I consume it and the amount of control I have over it.

Which brings me to Christmas. As I write this, it's 8:06 a.m. on December 25, and I am due at my sister's at 1:00 for Christmas lunch. On the advice of caring support professionals, I asked my mother to make her Christmas candies this year, something she hasn't done for the last couple. I can remember, years ago, looking forward to pies, cakes, rolls, macaroni and cheese, my mother's excellent sausage balls, her knee-weakening fudge, and her "buckeyes" - those chocolate-covered peanut-butter balls resembling the nuts of the buckeye tree.

Part of the bargain is that I have to eat them. And I shall. With relish. And I'll eat other things, too. 1:00 is a time I can work with, and I'm sure that the fare will include something safe enough for me to consume without Catholic guilt. I may not eat sausage balls, but I'll eat enough to substantially contribute to my meal plan for the day and to perhaps make me feel a bit normal this Christmas.

So, "healthy" holidays to all. To all, a good bite.

You Can, in Fact, Go Home Again

It may be a little weird at first.

It may not even be what you wanted to do, at least not at the time.

It's not so much that home is where the heart is -

Home is where the heart is welcome.

Last Supper

Today is my last day at the eating disorder center. I've known for about a week that I would be leaving, but the discharge isn't ideal and there was still some possibility of delay. Nevertheless, I'm just as subject to circumstances as the next person, and I tend to make decisions accordingly. Suffice it to say that I have major goals remaining, goals I'll need to meet. But I've improved beyond clinical expectations. I continue to. I must continue to.

But, more on all that later. This post is about last meals.

The nutritionist here usually asks departing group members to choose their final meal - most often a lunch, since that's our biggie. Today is Friday - Day of the Challenge Lunch (cue ominous music). So, challenge meal rules apply - namely that the meal must scare you, at least a little, and you must clean your terrifying plate.

I've struggled with various menu items over the past couple of months, and I will struggle with menu items when I leave. But that's a necessary condition for breaking free.

My last meal decision:  Beef. Particularly, lean ground beef.

More particularly:  A cheeseburger made with lean ground beef and a side of sweet potato fries (slightly "safer" than regular potato fries - perhaps irrationally so). I also requested a wheat bun option.

For dessert:  Whatever. Just not too heavy, considering the main dish.

Sure, my decisions might be based on eating disordered thinking. And they might not be.

It's so hard to tell sometimes.

A Damn Shame

All these bright, beautiful, talented, kind, wise, soulful people.

Girls and boys, women and men, young and not-quite-so-young.

For whatever reasons, unable to recognize, much less acknowledge and share, those electric qualities in themselves.

Qualities the world seeks, needs, but lacks in optimal proportions.

Qualities the world wants, though it might not always say.

The world hungers for completeness.

These bright, beautiful, talented, kind, wise, soulful people do, too.

Family Matters - Like it or Not

Friday, 9/30, was Family Day at the eating disorder center. The very idea of Family Day made me feel like I’ve been away at camp, though away at camp I’ve never been. There was a flyer announcement, an official-like agenda, a schedule. There was a boxed lunch, staff presentations to family and friends, Q&A, a keynote speaker.  There were flower arrangements on the tables, which we – the “campers” – designed and put together, bless our little hearts. The pomp and circumstance turned me off during the planning stages, and I argued a bit with the staff about the flowers, the new table cloths, the party napkins – even the normally-forbidden caffeinated beverages, some with calories and some without. Basically, I didn’t want Family Day to offer anything out of the ordinary, because that wouldn't be a true image of our daily lives. Rarely a flower arrangement and never a Diet Coke. Granted, the treatment team relaxed the rules for us on this "special" day, and I enjoyed the privilege of caffeine and the relative safety of the boxed lunch. It beat hell out of our regularly scheduled challenge meal, though the white sandwich bun and brownie were challenge enough for me (I overcame). Nevertheless, I wanted my parents, whom I invited, to get the full-on experience, to see how things really are. If I need permission to use the bathroom, why shouldn’t they?


For one, the eating disorder is mine, not theirs. A better question might be: Why should they be punished for it? Should the citizens of a "rogue state" suffer the consequences of sanctions on their leader? Although they may be complicit sometimes or tacitly consent, my parents are not, ultimately, responsible for my actions. They’re likely doing the best they can or, at least, the best they know how to do. This isn’t to say that they have nothing to do with the choices I’ve made. I lived with them for over twenty years, and their influence, along with the influence of my siblings, is pervasive. My influence on their choices is just as pervasive.  None of us fully understands the degree to which our lives and decisions are interlaced. Neither they nor I really know who’s in charge, or, as my individual therapist would say, who’s “leading the dance." No one person leads all of the time.
  
I do not make it easy for people to help me. I tend to sabotage potential support. Concerned family and friends probably get the impression that anything they might say to me is wrong. They would be right - I make it so. Telling me to “just eat” is bossy and betrays an overly-simplistic view. Offering me a salad or some other “safe” food is patronizing. Yet, silence is as good as encouragement. So, what’s a family member or friend to do?


Family Day!


I invited just my parents, because I wasn’t sure how many others I could handle in such a concentrated amount of time. Nothing against my brother, sister, extended family and  friends – but my parents are complicated enough. They divorced approximately a year ago, I guess (I don’t have copies of the paperwork).  In my opinion, the “official” split was long overdue. Until Family Day, they had spoken little to one another since the divorce and hadn’t spent nearly a full day together in the same building, much less the same room.


First, I was anxious about how my parents might behave, since I know there are many unresolved feelings between them. These are feelings that a court of law cannot adjudicate way. I’ve never known my parents to be happy together. Tolstoy’s famous first line rings eternally true. Even before the divorce, my siblings and I served as go-betweens for misaligned personalities. It isn’t that my folks consciously used us as middle boys and girls, now middle men and women.  It’s just that family systems have a way of doling out the roles required to maintain them. Eating disorders do the same. 


I was just as anxious about how deeply my parents and I might dive into my psychological state, particularly my feelings about them and about our relationship. While the eating disorder is “mine” alone – the identity it offers being part of its appeal – I use it as a way of dealing with the emotional “stuff” I’ve yet to consciously address with others. There is a lot of that, I think. Needless to say, I thought Family Day might get pretty heavy, and heavy is something the anorexic tries hard to avoid. It took me awhile to make the decision to invite either of my parents.


You might imagine how awkward their reunion was. I saw and spoke with them briefly before things kicked off (they did not ride together, of course). They greeted one another, but their tone, manner and facial expressions betrayed their discomfort. They were cordial enough, but I still saw the chips on their shoulders. The chips are there, regardless of what either of them might tell you.


During the first half of the day, family and friends were occupied listening to the staff’s presentations on eating disorders, their psychological and medical complications, the nutrition required to sustain normal human beings and effectively battle disordered thoughts and behaviors. My fellow group members and I went about our morning as usual, away from our visitors. We had heard it all before and would almost certainly here it all again. We practiced yoga as scheduled, and yoga – when you willingly and generously submit to the practice – has a way of putting things into perspective. At heart, yoga – and life – is about the breath. You can breathe through your anxiety. You can recognize your breath. You can focus on it. You can live with it, in it, through it. You are it. Without it, you are not. Breathing, you can essentially eliminate a lot of your worry about the horizon, because you no longer seek what might be on it. You are breathing. That is all. That is enough. This helped me get through a lot of my Family Day anxiety. It may sound to you like corny self-help juju, but yoga –  the breath – is just as much metaphor as actual practice.  It's taken me awhile, but I’m finally beginning to heed our instructor’s advice about letting yoga - the breath, the metaphor - inform the way I live out the other aspects of my life.


To their credit, my folks had agreed to set aside their own grievances for Family Day and try to be present for me alone. So, I would trust them. If I got burned, I could inhale the flame. Then I could blow it out.


Part of me wishes I had an action-filled climax to spice up my Family Day account, but I don’t, really. We – the campers – reconvened with our family and friends for lunch. My parents – sitting and eating together with me – spoke directly to one another, complete sentences. They undertook the conversation gingerly but with greater comfort than at the day’s start. They had learned a lot more that morning than I would have been able to objectively teach them.


After lunch, everyone got together in a room and sat in chairs arranged in a circle. Breathing or not, I felt a tinge of anxiety about this. I let it go. First, a former patient  – a fellow dude (represent!) – spoke about his personal experience at the eating disorder center and his continued recovery. Gender aside, his story was very much like our own stories. I took away a lot from his retelling, and I admire and appreciate his courage to tell.


Earlier in the day, the staff had given everyone – campers and visitors alike – a worksheet to complete.  This worksheet had four sentence fragments printed on it, all of them the same: “I wish my family member(s) knew…”

The staff asked us to complete the sentence – four times, fewer than four times, more than four times, whatever we could do. We would not have to read these aloud, they said, but there would be an “opportunity.” Yay.

We closed Family Day in our circle, group members sitting with their family and friends, me sitting between my parents. The worksheets  were out, the “opportunity” provided, the initial silence excruciating. I agreed to read some of my statements, but not all four of them. But then, as I began to read, I thought:  Fuck it. This isn’t supposed to be easy. To be effective, it has to be hard.

So, I read all. This, more or less, is what I said: 

• I wish my family member(s) knew…that I do not want to be this way, to have an eating disorder.
• I wish my family member(s) knew…that, most of the time, I feel uncomfortable around them, but that I wish this were not so.
• I wish my family member(s) knew…that I often worry about what they might think of me and am not always honest about my feelings with them.
• I wish my family member(s) knew…that I love them but often find it hard to do so. I harbor resentments that would best be addressed and which have grown stronger because they have not been.

Family Day went better than I expected, perhaps because I expected. It was a good day, regardless. I am glad that my parents came. I am relieved and thankful that they came in the spirit of the event and that they appeared to take some of that spirit home with them. We’ll see where this takes us.

Until then, I’ll keep breathing.

More to Come...

Forgive me Blogger - it's been over a week since my last post.

I feel like I'm slacking, and I probably am. I've been "processing" Friday's Family Day at the eating disorder center and hope to post something about that soon. Short version: Went much better than I feared it would. Lesson: Don't believe your hype.

On Getting What You Ask For, or Thank Goodness It's No Longer Last Friday

Every Friday, all of us pitch in to prepare a "challenge meal" for lunch. Our nutritionist selects the menu, the recipes, the serving sizes, and then we mix all of the ingredients together in bowls and things. If needed, we heat the admixtures using an appropriate appliance. This is called "cooking."

The Rule: You must finish 100% of challenge meals.

We have two per week - a Wednesday breakfast challenge and the Friday lunch. I try as much as I can to think of these meals as caring but tough-minded dares, friendly but still-uncomfortable invitations to dual - with food, with staff, with the eating disorder, with myself. Although challenge meals are those things, I still brace hard for catastrophe before them, still brick up walls around me and ready the catapults within.

To be fair, challenge meals have been a lot less challenging than I've expected. Friday lunches have included entrees like grilled salmon with pineapple salsa, grilled chicken stuffed with feta and spinach, and some kind of pasta with a peanutty Thai sauce. Yesterday we baked tilapia. This is pretty healthy stuff. The vegetable and grain side items, while not usually on my Safe Foods List, have been safe enough for me to make it through the meals. Yesterday's sides, for example, included spinach and arugula salad, which I helped prepare, and a whole wheat roll, which is a departure from the whiter bread usually “offered” with challenge meals. Of course, there is always dessert, which is something I continue to struggle with. But, despite a good deal of irrational fear and unjustified resistance - neither of which seems to have anything to do with taste – I’ve even managed to make it through the dessert portions of the Friday lunches. I know that things could be harder, the challenges more severe. Besides, I didn't come here to coddle or enable my anorexia. I came here to get the help I'll need to kick its ridiculous ass.

But I wasn’t prepared for beef.

The previous Friday, we had taco soup with Mexican cornbread and, for dessert, cake bites from a local, high-end bakery. During meal prep, I was stationed at the cornbread bowl with another group member and didn’t really think much about the other menu items. While not thrilled about the cornbread, whatever its country of origin, I stirred the ingredients without too much anxiety. Indeed, it could have been worse. Why I didn’t think more about the taco soup or at least ask what was in it is a mystery to me. I suppose I was accustomed to being “challenged” with foods within my safe-zone or gradually moving toward it. Even fried fish or fried poultry might have been okay. Fried = 1 Fat in the language of our meal plans, all of which require fat exchanges. Fish and poultry themselves have been on my Safe Foods List for years.

When I started the program, the nutritionist asked me about food preferences and special dietary needs. She noted that vegetarians, even vegans, complete the eating disorder program without having to offend Gaia or sin against the animal spirits. However, she champions the benefits of red meat, primarily because it is the “best” (i.e., most abundant) source of iron and zinc. This may be a major selling point for the healthy and legitimately health-conscious, but, even now, I’m not sure I really care. I told her that I don’t eat red meat at all - just chicken, turkey and fish - mostly for “health” reasons, but that I also think of the exclusion as a step towards making a decision to give up meat altogether. And it’s true: I have thought quite a bit about becoming vegetarian.  But, I made the red meat decision at about the same time I increased deliberate exercise and eliminated most high-sugar, high-fat foods from my diet. I used “health” as an excuse for emaciation long after the eating disorder had taken root, well into the spring and summer of its bloom. It’s a common excuse among the more restrictive eaters in treatment.

Part of the challenge meal philosophy is to encourage you to face foods you have eliminated from your diet so that you might then reevaluate your decision to exclude them. Anorexia decided much of my diet for me. It does it still. This is one of its greatest benefits and one of its most severe punishments. So, realizing that my red meat exclusion was probably…definitely…eating disorder related in the beginning, I agreed to try it at some point while in treatment – just to see. The nutritionist assured me that she only includes red meat in challenge meals when she feels that someone is ready for that kind of challenge. And she generally uses only lean cuts. Of course, our refrigerator always has red meat on hand, in one form or another, should any of us choose to add it to a meal of our own design. Nevertheless, we run out of turkey much quicker.

The taco soup was made with ground beef. Granted, it was a very lean ground beef, but beef nonetheless. Granted also - beef is probably the most common meat found in taco soup. But you could just as easily use ground turkey or chicken or tofu or just go heavy on the beans. And you could even more easily mention the potentially terrifying ingredient to the people making the Mexican cornbread. I only realized what was in the soup when it and the cornbread were ready to eat. I saw the pot, noticed the meat, and asked, “What kind of meat is that?”  In unison, the nutritionist, other members of the treatment team, and one or two group members (fellow patients) answered:

“Beef.”

Silence.

Or, perhaps it was only me. A mere second or two following the reply, I drew in a very deep breath, tightened every muscle in my body, and held the breath inside. Those who tell you about the virtues of deep breathing intend for you to exhale. For awhile, I did not. Instead, I bricked up walls around me, fumbled with the catapult within. This is what happens when you let your guard down. This is what happens when you trust. This is what happens when you assume. This is what happens…

One therapist: “Justin, remember what we talked about yesterday during the group session, about challenging thoughts and beliefs…could you maybe use some of that?”

Me: “No.”

I took my bowl and sat at the table, in the chair where I usually sit. The nutritionist took the chair to my right, at the head of the table, where she usually sits. I wouldn’t even look at her. Nor would I look at much else besides the hideous table-cloth and the contents of my bowl. They tried to draw me out – the nutritionist, other staff members, fellow group members. They tried to get me to express my feelings as if I had any idea what feelings to express. Later, after having had some time to “process” the ordeal, I realized that these feelings were something like anger, resentment, fear, distrust.

The nutritionist: “I’d challenge you to eat this mindfully.”

Me: (thinking) Fuck you. (saying) “I don’t want to talk about this. You sprung this on me and now you want me to talk about it. I’m not going to.”

To make matters worse, I had agreed to a family therapy session with my mother via videoconference, which was scheduled to start less than an hour after the offensive lunch. I had been reluctant to do family therapy previously because 1.) I’m “too old” for that shit, and 2.) I’ve never been confident in my family’s ability to help.*

The nutritionist didn’t know about the session with my mother. Had she known, she might have saved the ground beef for another day. But I probably would have reacted just as unreasonably.
This is the main lesson I took from the experience: I still act unreasonably as a knee-jerk response. Some of those Cognitive Behavioral Therapy (CBT) skills that we discussed the previous day or the Distress Tolerance skills of Dialectical Behavioral Therapy (DBT) would have come in handy had I been willing or mindful enough to use them. One therapist had tried to point me in that direction, but, by then, I was too walled in to feel, much less accept, her gentle guidance. I refused to even see that it was gentle.

At the end of challenge meals, we have a “meal process group,” which is when we take time to discuss the meal, our feelings about it, and ways to deal with them. For the record, I finished the meal but didn’t really taste it. After the beef taco soup, I sure as hell didn't want to participate in the process group.

Alas, too bad.

So I begrudgingly played along. I talked about feeling as though the beef was “sprung” on me without warning. I talked about how I felt betrayed, my trust broken. I talked about these things while still unwilling to make eye-contact, especially with the nutritionist, who was the unlucky recipient of the worst of my reaction. (In the language of psychotherapy, this is called transference.)

The nutritionist: “Remember a couple of weeks ago, when I asked you if you thought you might be ready for red meat?”

Me: “I told you that I didn’t think I was ready yet but that I thought I would definitely need to try it at some point.”

The nutritionist: “I asked you if you would want me to tell you beforehand that we were going to have red meat as part of a challenge meal. I asked if you would rather not know, would rather be surprised. You told me not to let you know.”

She was right. I said that. I had given her permission to “spring” red meat on me.

This is the part where the anger, resentment, distrust, fear, and, now, embarrassment become too great to contain. But, because I fight emotion, try to hide it away, refuse to find my lion’s roar - which is just so much spring-loading - it all comes out in tears. And I fight these, too. I WILL NOT ALLOW THE WORLD TO SEE ME THIS WAY! I WILL NOT BREAK DOWN BEFORE YOU! IF I DO, I WILL DO WHATEVER NECESSARY TO SAVE FACE! I AM MACHO! I AM STRONG!

I am a mountain formed of papier-mâché. I am a 30 year-old child.


*After a few minutes alone with my thoughts and a cigarette, the therapy session with my mother went well. I let her know up front what I was dealing with, and she generously beared with. She's a pretty cool lady. 

Weight Weight...Don't Tell Me

We weigh first thing every morning. At least those of us on weight-gain meal plans do. Eating disorders range from binge eating ("too much") to anorexia ("too little"), with various combinations in between. So mandatory weigh-ins depend on the nature of your disorder and where you are in the process of recovery. The eating disorder center treats all varieties of eating disorder.

I learned very early to single-knot my shoe-laces when first tying them for the day, since this makes it quicker and easier to remove the shoes for the big event. When I arrive, I immediately take them off and empty my pockets in preparation. I feel a lot like I'm being booked in the county jail or passing through airport security. (I've only ever experienced one of these, and I'll let you guess which one.) I feel weird, a bit violated, childlike, distrusted, and angry. When finished with the scale, I tie the extra knot in my laces, reload my pockets, and then make my way to the kitchen for breakfast. Before I came here, my individual therapist back home weighed me similarly before each session. I may have felt just as uncomfortable, angry, or criminalized during those weighings, but I didn't see her five days a week.

We also weigh blindly, meaning that our backs are turned towards the wall opposite the scale, away from the digital screen and its electronic measurement. For someone who restricts their eating, this is not a terrible way to go about it. I stopped weighing myself years ago, because I knew that a pound gained would become two lost in the name of overcompensation. Except for when I initially began to "get healthy and into shape,” my eating disorder has never been about weight-loss. Rather, it has been one way to control something, anything, and I've used it more as a maintenance tool. My fear, on the surface anyway, has been weight-gain; my goal - constancy, predictability, security. Overcompensation is my gut reaction to a hike in the gravitational pull. This tendency can be more or less dangerous depending on how thin you are. Yet, now that I think about it, I've never overcompensated for weight-loss. Indeed, the lower weight has always become the new weight to maintain. I chase my tail only to let go once I've captured it.

So, maybe the eating disorder is about weight-loss - on the surface, anyway. Below the surface, prehistoric beasts are fighting to survive.

I worry that when I leave here...

...I'll find it hard to adjust to an unsupervised diet, to full weeks spent back home, to work - provided that my spot has been saved...

...because I also worry that I'll no longer have a job, that my first taste of "normal" life will be the bitterness of unlucky nose-to-grindstone, employment searches, interviews, bullshit résumés and bullshit job descriptions - an environment known well by so many people right now, an all-too-“normal” state of things...

...and I worry that, once left to myself, I'll succumb more easily to triggers, especially newer ones, like others noticing my more substantial mass, commenting on it with best intentions, but not realizing that stubborn, illusory perception often overpowers intention...

...for I further worry that, even if I maintain a healthy weight, I might also maintain an unhealthy tendency towards perfectionism, towards control, towards obsession and compulsion, towards both narcissism and pallid self-esteem – towards a much longer list of thoughts and emotions descending like stairs from surface to core – the same ones that got me here.

Worry may well be the parasitic worm of the mind. It does nothing for you. It takes much from you. Acceptance is its only effective exterminator. You can change neither past nor future. You can only change the now. And you can only change the you that is in it.

This is not original insight. So why is it so hard a principle to use, to live by?

Does anyone have Bobby McFerrin’s number?

Round 2: Me vs. The Cookie (Reprise)

Tuesday, we ordered boxed lunches again from the restaurant whose boxed lunch comes with a gigantic cookie. My anorexic mind thinks of it as the kind of cookie Godzilla might eat after an entree of human flesh. My reasonable mind thinks, "WTF is your deal, man?" Nevertheless, Round 2 of the epic duke-out goes to me. I ate the chocolate chip "treat" first - before sandwich or chips. I enjoyed its texture and taste (chocolate chip cookies were a favorite of mine in a past, less complicated life) but pretty well forgot about it once I moved on to the main event. That's right: Neither of us - my sugary opponent nor me - holds a title belt. No championships hang in the balance. We swapped our pugilistic licks before all your guests arrived for the marquis match, the one you dropped $59.99 to see. Our promoters still work nights at Publix; our trainers still bum cigarettes from the mothers with whom they live.

But, we're making our way up. I believe I am, at least.

The Saturday Evening Almost Post

I planned to post something yesterday. It had been a couple of days since the last dispatch, plus my mother was asking about the www.silence. I have a lot to talk about in general, but little to suggest where to start. So, yesterday I began to write about Jungian sand tray therapy, which is a little bizarre, sometimes off-putting (I broke down during one follow-on group interpretation...big, embarrassing tears), but kind of neat, too. I could have also written about how I became an unpaid (paying, with insurance help) music therapist. Or, I might have just written a little about the program's schedule, which even now I'm a bit sketchy on. Another topic fresh in mind was Thursday's attempt to down a milkshake without any ra-ra-ra group support (finished around 3/4 of a pretty large cup). These are all things I may eventually discuss.

But, I posted nothing.

Instead, I spent the better part of Saturday afternoon and evening searching the web for an answer to one of those grand, cosmic, philosophical, humanity-in-the-balance types of questions:

What kind of milk does Starbucks use as a standard in its Frappuccinos?

My daily meal plan includes four supplements, which can be any combination of Ensure Plus/Boost Plus (or generics), Cliff-type bars, and "fun" foods, as the nutritionist calls them. Fun foods include cookies, muffins, cake, pie, ice cream, milkshakes, etc. The supplements provide "energy" in addition to what I get from the balanced meal plan. The plan is more structured and manageable than "Eat, Eat, Eat! Gain, Gain, Gain!" But, I'm quite aware of the broader goal and its fight song. (I'm actually sipping an Ensure Plus as I write this - Supplement #2 for the day.)

Yesterday, I decided to have a Caramel Frappuccino (not a Caramel-Lite) at Starbucks, but not before going to their website and looking at the nutritional info. I would count it as one of my supplements for the day, but I wanted to ensure (no pun) that it was within the caloric range of the other supplements I've been consuming (nevermind any caffeine cancellations). The website confirmed that it was, and I assumed that, since the milk selection defaulted to 2%, 2% milk must be the Starbucks standard if you don't request something else. I couldn't remember what milk we used when I worked in a Starbucks-affiliated Barnes and Noble Cafe years ago. But it didn't matter, since the Starbucks website defaulted to 2%. Right?

If only I could have stopped there. I actually did stop long enough to order and drink a Caramel Frappuccino, which automatically came with whipped cream drizzled with caramel sauce (not considered earlier). I drank the entire drink except for what whipped cream/caramel sauce I could keep from mingling with the base below. Afterwards, I went back to the Starbucks website (they love repeat visitors) to see what whipped cream/caramel sauce might do to a man's supplement. Turns out - quite a lot, but, even so, I was still only 40-50 calories ("energy") over what I would have gotten from an Ensure Plus. By no means an End-of-Times issue, even for a recovering anorexic. Yet, I began to question whether 2% milk is the Starbucks standard. There were, after all, other choices  in the drop-down menu on the website, and I remembered seeing loud ads encouraging Frappuccino "customization." So, I nosed around the site a bit to see if it mentioned a standard type of milk. I had no luck finding a definitive answer, even after several site searches and a close-reading of the drink FAQs.

What to do? Google, naturally. I spent a lot of time with this, only to turn up some statements confirming 2% milk and others declaring whole to be the standard Frappuccino ingredient. I won't list my specific sources, most of which I don't even remember, but they included several forums, question-answering websites, press releases, news articles, etc. Why didn't I just call the local Starbucks? (Seriously, if you know, please get in touch.)

Suffice it to say that I did not get a chance to do anything worth really doing in Birmingham last night. Suffice it further to say that I haven't done much worth doing over the last 5, 6, 7 years. I lose count. This makes me a bit sad.

But, treatment is changing this, just at a pace that makes it hard to tell. As with the condition itself, it might be futile for me to attempt explanation, so  I won't. I'm getting better - believe it or don't.

How did you spend your Saturday night? Doing something worthwhile, I hope. Do tell. I want gritty details, people.

Silly Smoothie Pictures

I took these Tuesday afternoon because:

1. Why not?
2. I wanted proof to show the treatment team, group members, and others that I drank a smoothie (chocolate/banana) - a small thing for most but a significant stride for me. 
3. I could think of little better to do. 
4. I had a smoothie and a camera at the same time. Only fools squander the gifts of the Fates.  

The official documentation.



The first sip. On another note: Should I get those moles checked out?

Yay. Smoothie.

Uh-oh. Look who's drinking a smoothie.

Really becoming aware of the camera now. This will not end well.

Pssst...over here...behind the smoothie.

Smoothie. What fun.

Hard to tell, but that guy is either some sort of Catholic monk or the drummer for a Neo-Medieval metal band.

Nearly finished and fascinated by the Starbucks Siren. Reminded of Odysseus' encounter during his decade-long trip home following the Trojan War. My return home should come sooner than that.



No smoothie experience is complete without the brain freeze.


So, that's that. The smoothie was tasty and I didn't freak out. Next step? Whipped cream? Do I dare?

Peace.

Cloudy with Slight Chance of McFlurries

After last Wednesday's cookie episode (a kind of anorexic Episode I: The Phantom Menace), I decided that I would make up for it by drinking a milkshake or something similar on Thursday. When I mentioned that as one of my goals for the day during Thursday's Goals Group, the therapist and group members suggested a McFlurry from McDonald's. A McFlurry is essentially a thicker milkshake, I guess, and I didn't feel like arguing. I did, however, argue with myself throughout the day. I began to modify the goal to include the possibility of getting a smoothie instead of the more "dangerous" milkshake or McFlurry I had committed to. The therapist called me on it - she let me know that a smoothie was a safer option and helped me to realize that I was again talking myself out of taking a risk based on an extreme, perhaps unjustified, fear.

So, I ate an Oreo McFlurry. But I had generous backup. Knowing that I was anxious about it, the whole group (which is small right now) accompanied me to the Golden Arches during snack-time so that I could order my fear and eat it, too - with others enjoying desserts of their own. It was blown a bit out of proportion, as much by me as anyone, but I finished the McFlurry and enjoyed it at the time. I was thankful for the moral support the group provided, but my eating disorder wasn't as appreciative. So, later that evening I did some exercise - which is prohibited for me, or, at least, against recommendations. It wasn't too intense, but, still, the treatment team recommends that I refrain from any exercise besides yoga until I've put on enough weight to support greater physical activity without burning excessive calories and shedding hard-won pounds.

On one level, I think the McFlurry was a success. I ate it, which was my goal for the day. But, all the same, I subsequently engaged in "behaviors," as we call them here.

Either way, I've still some work to do...

On Feeling Like a Bit of a Slacker and Playing Eating Disorder Jenga

When you say, "I'm going to do a blog," or make similar claims, you sort of have to do it. At least, I feel obligated to follow through, even if that obligation is created and defined by me. No one told me I have to do this, nor has anyone vowed to hold me accountable. My obligation is just part of the too-hard-on-myself, perfectionistic nature of my personality and a key component of my eating disorder.

Which brings me to yesterday's game of Eating Disorder Jenga. Sometimes we experiment with therapy that seems a bit childish - like playing board and party games, or making hula hoops and then using them as intended (though, for me, even hula hooping is banned - exercise). But "childishness" and "play" are important parts of a lived life. Maybe even the best parts.

Eating Disorder Jenga is a variation on the popular party game that requires players to delicately remove one of the wooden blocks in a tower of stacked blocks, with each block numbered to correspond to a question about eating disorders. The player then provides an answer to the question. For example, "What are three of your eating disorder triggers, and what are some ways that you cope with them." The idea is to understand - more objectively - your condition and its associated behaviors as something distinct from you - the Hyde to your Jekyll. Perspective, you know.

I noticed that I always looked first at the most precarious blocks to pull from the leaning tower. For some reason, I wanted to pull off the grandest feat by pulling out the blocks most likely to bring the tower down. Why is this? Because I set unrealistic expectations, am often much harder on myself than on anyone else, and am prone to perfectionistic thinking. So, Eating Disorder Jenga, childish though it may be, did what it was supposed to do. It made me ever-more aware of this character flaw. It made me more aware that all character is flawed. Which sounds negative, but might actually be freeing.

More to come. I will fulfill my self-obligations!

Lift the Heart: It's Yoga Monday!

I just got back into Birmingham a little while ago after spending the weekend at home in Huntsville, and I'm a bit tired from the drive. I was probably tired before the drive (embarked really early), but the drive turned out to be unhelpful. I actually ran over something on the interstate - a box?...a forgotten item of furniture?...a magical gnome on his way home after a night of gnome partying? The morning darkness concealed whatever it was until too late. The right front side of the car looks okay, but there was noise enough for concern. (None of this has anything to do with my post-drive fatigue. I just thought it interesting.)

Given that I'm tired, I look forward to yoga today. But then, I look forward to yoga on all yoga days. We practice yoga (therapy) Mondays, Wednesdays and Fridays, and it always seems to give me peace and energy. (Even though the nutritionist refers to calories in any form as "energy," she unfortunately doesn't consider yoga "energy" to be a legitimate meal plan item. But, if I added sour cream...) Our yogi, guru, mystic, or whatever you prefer primarily teaches and practices the Ashtanga yogic form, which is a higher intensity style than some of the other, more popular forms. (For a slideshow of poses, go here: http://www.ashtangayogi.com/complete-asana-slideshow/index.html. Ashtanga, like most physical activities, is something best begun with the guidance of an experienced teacher. Not something you want to try at home alone first. And if you're wearing what the guy in the slideshow is wearing, maybe not something you want to do with the blinds open.)

So, that's it for now. Yay for yoga! Later today, I hope to "process" and write about some things that occurred or that I thought about towards the end of last week here and over the weekend at home. Until then (or even later, depending on how persistent my goal-getting is today): Namaste.

You Can't Write this Stuff - But You Can Take Pictures!

Meet the eating disorder center's next door neighbor:

To be fair, there's a second part to the marquis message, which makes things a little clearer:

Fitting or totally inappropriate? Interesting, that's for sure.

As if that's not ironic enough, we had a visit last week from the Chick-fil-a Cow, who was passing out free breakfast items. I don't think the cow or the woman leading her around the neighborhood gleaned the same significance from the visit that we did. The heifer and its herder were just trying to promote fast-food chicken over beef. Little did they know they were preaching to the choir, although many of this choir's members go even further to sing the merits of baked or grilled chicken exclusively. I actually posed for a picture with the cow and another member of my group, but I hesitate to share it here, given privacy concerns. In the picture, I'm enthusiastically thrusting a foil-wrapped breakfast burrito towards the camera, and I'm grinning big. I love this kind of stuff. I even graciously accepted the burrito, which I put in the fridge and encouraged others to eat (someone eventually did).

Thanks for stopping by, Chick-fil-a Cow. Did you see that they're offering a free liposuction seminar next door?

Actually, I Am Getting Better

I realize my previous posts might give the impression that I am improving little or not at all. Make no mistake: I am making progress. It’s slower than I had planned, but I usually ask more of myself than is healthy, regardless of how perfectly the planets must align for me to get even close. Unrealistic expectations, perfectionism, “black-and-white” thinking – these are all part of the anorexic mindset, which devolves even further into ridiculousness as the mind and body progressively starve. This is why treatment professionals tend to stress refeeding as the first task of anorexia recovery. Sure, you might simultaneously undergo psychotherapy, art therapy, group therapy, and more. But these require a patient’s cooperation and fairly active participation, both of which become likelier with increasing nourishment. Unfortunately, treatment professionals encounter a lot of patient resistance to refeeding. After all, the medicine they recommend is the very substance the anorexic patient fears and tries to avoid.

I have been meeting and often exceeding my meal plan requirements. I am steadily gaining weight, and I haven’t heard anyone recommend residential inpatient hospitalization (i.e., Anorexic Alcatraz) for me since I first enrolled in the program. I’ve been consistently gaining enough weight to keep the treatment team from pressuring me too much about it. The nutritionist usually adds more to the meal plan (which is a minimum) each week, and she has mentioned that, although consistent, my gains are occurring at a slower rate than she would prefer. But the gains have been large enough and fast enough to keep me here at the intensive outpatient program in relative freedom – between The Rock (residential inpatient hospitalization) and The Hard Place (minimal supervision, perhaps even self-directed recovery, if recovery at all).

Evidence of my progress: Despite continued fear and avoidance of some foods like cookies and similar desserts, I have occasionally eaten them anyway. Friday, I had banana pudding and can admit that it tasted really, really good. Afterwards, I felt a bit guilty and usually do after eating things I had given up to the demands of the eating disorder. That I can choose to eat fear foods and recognize that I enjoy their taste is proof that I’m committed to getting better and am actually doing so, even if I still need coaxing and sometimes still resist. I have also significantly reduced the amount and intensity of my exercise, which I previously used to compensate for or balance my caloric intake, and vice versa. While not totally compliant with the team’s exercise ban – i.e., no exercise for Justin except for the program’s thrice-weekly yoga therapy (which is great) – I’m getting there, becoming more and more comfortable at rest. The yoga helps.

Perhaps the best evidence of my improvement is that I’m willing to talk more about this and with an ever-widening audience. Q.E.D.

Me vs. The Cookie

Today I went to the internist for a follow-up ultrasound, scheduled after the results of last week’s blood work indicated high liver something or other. During my initial visit, the internist (or, rather, her staff) performed an EKG and drew blood for tests. All patients here undergo this regimen at least once, primarily to make sure that they're not only still alive, but that they'll probably be for awhile longer. No big deal. However, my liver whispered funny things to the blood they drew, so today's abdominal scan was scheduled. Afterwards, the doctor reviewed the glamour shots and told me that they looked good. (Score.) Even so, she ordered more blood work for additional tests, and I hesitantly offered my right arm to the Transylvanian technician. Despite my aversion to the needle and to watching my blood leave my body, no big deal.

The big deal came later at lunch. I missed breakfast at the eating disorder center because the abdominal ultrasound came with a don't-eat/drink-after-midnight prerequisite. We eat breakfast together at 8:30 a.m., but my appointment was set for 9:30 a.m. I agreed to eat something immediately afterwards, and I did, meeting all the requirements in the breakfast block of my meal plan. Then I chugged the first of two daily supplements (Ensure Plus or something similar). This was around 10:45, with our 12:00 p.m. lunch already peeking out from behind the shrubs. By the time it was in full view and approaching, I hadn't managed to generate enough hunger to meet it with a smile. (Note: Anorexics aren't usually all that open to meals anyway.)

But, I had to eat lunch - you know, meal plan and all. Today's fare was a boxed lunch from Honey Baked Ham. The nutritionist chose my order, since I was probably wiping away ultrasound goo when she asked the others for theirs. She understands me well enough to know that I prefer turkey to ham, and I’m fortunate enough to have a nutritionist who doesn’t feel the urge to screw with me. So, a turkey sandwich it was, with baked lays and a chocolate chip cookie, both of which were part of the box deal.

First thought: Do they not offer a wheat bun option?

When I asked aloud, the nutritionist said no.

Second thought: If I eat the entire lunch, I'll exceed the lunch requirements in my meal plan by a couple of exchanges (1 grain and 1 fat, to be all too specific). Sooo...maybe I'll forgo the cookie (the major culprit and an item I cut out of my life a long time ago) and meet the requirement-compliant portion of it with something else containing much less sugar (something I all but eliminated from my life long ago).

Third thought: Eat the damn cookie! Your weight-gain meal plan is a minimum, and the treatment team encourages you to exceed it. They've suggested milkshakes, for crying out loud! Stop treating the plan as a maximum. You'll gain weight faster and get out of here faster. What's your freaking deal!?

I decided to eat the cookie - last, as dessert. After all, it would give me some of my daily energy requirements and, if I stuck to the meal plan without compensating for the additional exchanges later in the day, might help me gain weight faster - highly recommended by the treatment team. Besides, it's just a cookie.

Fourth thought (after eating the sandwich and chips): The cookie. You know, you've already met your grain requirements for the lunch block and are only missing 1 fat. Why not just eat a few almonds to get that in? It feels like you just ate breakfast moments ago, anyway.

I decided to eat the almonds and "save" the tightly wrapped cookie for another meal or snack (another's meal or snack, if lucky). But, the nutritionist noticed me rummaging the cabinets in search of the almonds, and probably noticed how I guardedly doled out the too-precise quantity with my back facing her.

"Whatcha looking for, Justin?"

"Oh, I found them. I was just getting some almonds."

She didn't reply, but we've had cookie discussions before and my cookie was still in the wrapper.

After downing the “better” fat exchange and taking my seat at the table again, she asked, "Where's your caloric drink?" 

Those of us on weight-gain meal plans are required to have a caloric drink - such as milk or juice - with meals and snacks. These caloric beverages can count toward meal plan requirements - e.g., a cup of milk (soy included) counts as a dairy exchange and half a cup of fruit juice counts as a fruit. Until this moment, I had been drinking water with meals that already met dairy and fruit requirements with solid food - like cheese or actual fruit. I figured such an exception was allowed, but, really, I always wondered if I should ask to be sure. Apparently it's not.

"I had cheese on my sandwich and ate an apple, so I got those in."

"The caloric drink can count towards your exchanges, but, regardless, you're supposed to have one at each meal."

Fifth thought: So, you've essentially just dictated how I'll get my dairies and fruits for the supervised meals and snacks I have to eat here – breakfast, lunch, and afternoon snack.

I didn't argue and poured a cup of soy milk.

Sixth thought: I can always compensate for the additional exchange at the unsupervised dinner or late-night snack.

Later, when I jokingly mentioned the episode to one of the therapists, she said she knew (i.e., already) that I had avoided the cookie.

Seventh thought: She wasn't there, so the nutritionist must have spread the word like the peanut butter I've been eating so much of here. Conspiracy?

Welcome to the anorexic mind. Enjoy the tour. The John Malkoviches live over there.

To Begin...

When I first thought to start blogging about my ongoing stint in an eating disorder treatment program, I figured I would provide some background on my experience with anorexia nervosa. This was to include as complete an historical account as my memory was capable of providing, perhaps with a few embellishments – some intentional, many not. However, I'm not going to do this. No matter how comprehensive my account may be, I still don't really understand how, why, or even when specifically I became anorexic. Educated guesses are still just guesses.

Ultimately, I have to focus on getting better using whatever exercises, methods, therapeutic schools of thought, nutritional plans, etc., etc….I have to use whatever works or could work to help me get well. The past can certainly be useful, but today’s commitments provide "here-and-now" material for "here-and-now" action. And action has the final say in whether or not I change. I could talk forever about my history and endlessly interpret and reinterpret its instructions and guidance. But, all the same, I'd be guessing. Not to mention that I tend to use analysis of the past as a safe, perhaps false, way of addressing my condition. Thinking back is a convenient way to occupy your time when you are afraid to think presently, and the same goes for thinking ahead. Plus, you can’t act on thoughts of past or future events. On present thoughts you can.

All of that is to say that I'm going to report on my everyday experience here at the eating disorder treatment center. I'm over 3 weeks into the program, so I may make up for lost time by writing a bit about the past 3 weeks; but I'll try to keep the time machine within that limited airspace. Inevitably, I'll say something about the extended past and predict the future, elaborate on memories or prophecies brought up by the present day's events. But, hopefully, most of what I post here will remain present-thinking. Hopefully, what I post will show daily progress towards a mental state where I might just think less and let my emotions have more of the floor. Hopefully, I’ll stop hoping and start doing.

Please comment liberally, and help me to keep on track.