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.