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Perception is Reality

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In “A Beautiful Mind” John Nash, a Nobel Laureate in Economics, talks about how he learns to cope with his hallucinations by ignoring him. That is a pretty amazing thing to do for someone who has schizophrenia. There are several disorders in which the person’s thoughts are so convincing, despite being false, that it is difficult to cope with them by deciding that you’re not going to listen to them.

For example, someone with anorexia may truly see herself as being fat, even though intellectually she knows that she is not. But her inner critic is so persecutory in its insistence that she not eat, not take up space in the universe, that she ultimately gives in. People with eating disorders often conceptualize their inner critic as having a relationship with ED, and ED is the most abusive partner I have ever met in therapy.

Or someone who is psychotic might be convinced that he is going to win a million dollars because Publisher’s Clearing House has told him that he may have already done so. And despite the fact that the check has not arrived in the mail after several years, he makes outlandish purchases based on the prize money that he is convinced is on the way.

I do not have delusional thoughts, but sometimes my obsessive brain tries to convince me of things that are not as insidious but still cause me to suffer. No one gives a crap about me. I am incompetent. Sometimes I can convince myself otherwise with objective evidence, but sometimes my inner critic is relentless in trying to convince me of the veracity of these assertions. It will repeat them hundreds of times a day. The effort to refute them is exhausting.

My psychiatrist tells me that I should put myself out of my misery at the beginning of this barrage by taking an Ativan as soon as the thoughts begin. But often I don’t because, despite all I’ve said about the importance of taking meds, sometimes I still don’t want to. And because, unlike depression, anxiety feels so normal that sometimes I forget that it is not. The meds definitely help. Most of the time I know that when the thoughts come, they are not true. But sometimes it takes a lot of work to keep them at bay.

Practicing mindfulness helps, too. One of the benefits of practicing is that it helps you understand the nature of the mind. Even for “normal” people, this is how the brain works. Random thoughts will pop up. They may not be based in reality, may not reflect what you actually believe. And in the next moment, the thoughts may be completely different.

But it’s really hard. Maybe if I dedicated my life to meditation like Buddhist monks do, my inner critic would be less effective in undermining my self-worth. Or maybe Buddhist monks don’t suffer from mental illness.

But my psychiatrist supports my mindfulness practice, in addition to my meds. He confirmed that it works, even for people with mental illness. But it takes a long time, and it happens very slowly. I know it works because I remember what I used to be like. And now when I go several days without meditating, in my moments of weakness the thoughts creep in and become more convincing.

So I continue to practice, and in the moment, I feel loved, competent, and worthwhile. So I’m writing this post to remind myself that this is true because, in the next moment, I may feel differently.

Roadmaps

Road maps

I have a special guest blogger today! She is one of the members of our Body Image Support Group, and I am so thankful that she is a part of it. In almost every session, I find an excuse to make her share her list of reasons for why she did not want to count calories because I love the list so much. I asked her if she would be willing to write a post for my blog so that all of those readers out there who struggle with mental illness can see that there is light at the end of the tunnel, regardless of how long that tunnel may seem.

***

It is a sad truth in our society that many people struggle with eating disorders. Moreover, just like any other mental illness, its spectrum is broad and deep. It is a big city that some people travel to and then leave after a short stay, while some set up residence in its limits and never leave. It is also full of invisible smog that suffocates and kills. I know this place like I know myself. I wore that citizenship like a second skin for nearly ten years of my young life.

I know the city like I grew up there, because in many ways, I did. My mind spent its adolescence wandering the streets of self-hatred and the alleys of obsession. It was easy to forget that anything else existed. I did make half-hearted attempts to recover once or twice in my teenage years, but these trips weren’t long—my permanent address remained the same.

It wasn’t until two things happened to me in college that set in motion my decision to leave and permanently depart from the city of this illness. One: I found my passion, writing. Two: I started going to therapy. Writing became a creative, constructive obsession that helped me face and make meaning from my eating disorder. Therapy allowed it to bubble to the surface and become something that was a crucial roadblock in my development of an authentic self, rather than a part of my identity as a person. These elements combined to free my mind to the rest of the world. As a result, I have opened up more to my peers, my surroundings, and the prevalence of eating disorders and their immense harm at my small university and in Western culture.

Therapy and creative writing both helped me put my eating disorder into words. In doing so, I realized that not only could I put it into words, but I could also fight it with words. Language—what we tell others, what we tell ourselves, what we see and choose to believe as truth—is the most powerful tool there is.

Here’s one of the ways that positive, empowered, truthful language has saved me: as I neared the end of the recovery process this summer, as I learned to love my body and myself, one thing that I had to work extremely hard on was not counting calories. Even as I had gained weight, even after I abandoned my eating disorder, my mind still wanted to walk on its sidewalks—they are straight, even, and predictable. They are safe.

Yet, a bigger part of me knew that I was lying to myself, that counting calories is like living in the suburbs of a city to which I never want to return. I had to force my brain to stop counting calories, and it was one of the hardest things that I have ever done. It was mentally difficult not because of emotions or intellectual depth, but rather because the sheer force of habit is a brick wall that is nearly impossible to scale. But I did it. One thing that helped—or perhaps, the main thing—was the creation of this list. The list started as a statement that I heard from a friend, and it developed over several weeks. The list is a roadmap for departure from my eating disorder, a map that only gives directions one way. The day that I decided to stop counting calories for good was the day I was truly recovered.

Reading this list every morning became a ritual that replaced the obsession of calorie counting. It nourished my mind like the food and love that I had gone for so long without. As I continue to think about combating unrealistic standards for women and other causes of my and many others’ body image struggles, I keep this list in mind. Though at this point I do consider myself fully recovered, this list reminds me the importance of not turning back. In continuing to write about eating disorders and other issues, the empowerment of this list remains with me, too. The list is specific to me, but it also isn’t.  It is my hope that it can resonate with others, too.

  • Because my body isn’t a project.
  • Because my body has a voice.
  • Because I am not my mom.
  • Because I might have daughters.
  • Because my body deserves kindness.
  • Because I want to be able to say honestly, “I am over my eating disorder.”
  • Because food isn’t a reward or a punishment.
  • Because being skinny doesn’t get the kind of love or attention that I truly want or need.
  • Because being skinny doesn’t result in anything that is good for my mind or my soul.
  • Because I can’t think about other things or be my best self if I don’t eat enough.
  • Because I shouldn’t waste thoughts on calories.
  • Because I need and deserve nourishment.
  • Because I expect others to respect and to be kind to my body, so I should respect and be kind to my body, too.
  • Because growth is necessary.
  • Because life is short.
  • Because even if it feels impossible, the alternative isn’t an option that I can live with. Life is for living, not controlling. I can eat what I want.
  • Because no one else really cares what my body looks like.
  • Because I am a strong woman.
  • Because it is a mental, chemical problem that I can’t just wish or talk away.
  • Because I am a hard worker.
  • Because counting calories and controlling food never results in ANYTHING valuable.
  • Because thinness is not part of my identity. Neither is smallness.
  • Because I would disappoint people who might respect or believe in me.
  • Because I don’t want to trigger someone else.
  • Because it’s not just about eating disorders, it’s about inequality, which I can fight IF I start by confronting myself.
  • Because the pain of change is better than the pain of staying the same.
  • Because I believe in change. I believe that people can change for the better.

Annie Persons is a senior English major and Creative Writing minor at Washington and Lee University. She enjoys writing and hopes to teach one day.

For the Love of Food

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Kids grow up so fast these days.

I spent Thanksgiving with my niece, and since I only see her every few months, I am keenly aware of every change that takes place in my absence. The addition of Seriously?! into her vocabulary. Her latest career aspiration (humanitarian and veterinarian). The evolution of what it means for her to be a girl. Thank goodness that now includes sports! It makes it a lot easier to watch UVA football and basketball games when I’m down there.

On this trip, her latest thing was to ask how many calories something has and to obsess about being skinny. Did I mention that she is eight years old? I specialize in eating disorders, so I’m well aware of the stats on how early girls begin to worry about their weight, but it’s still shocking to see it play out in real life.

One of the things I’ve always loved about her is how much she enjoys food. When she was a baby, one of her first words was cake. Desserts were usually the most memorable part of any family gathering for her. And whenever she eats, she hums to herself and periodically shakes her hands over her head like kids do when they’re excited. So when we went for brunch and she asked me how many calories pumpkin waffles had, I was disheartened.

I’ve never had an eating disorder, but I know how it feels to spend your life worrying about getting fat. I didn’t start worrying about it until I was about 25, which is pretty late in the game these days, but that’s still 20 years of my life that I’ve spent thinking about the state of my body. I obsess less than I used to, but I still monitor my weight.

I’ve always been a little turned off by the campaigns to combat all of the body image brainwashing. Especially the suggestion that we should compliment people on their personality rather than their appearance. That seems incredibly unrealistic to me. But maybe I’m just vain and superficial and want to hear compliments about my appearance.

Even focusing on eating healthy and exercising can be problematic, because anorexia often begins with that very goal. Being extremely health-consious and fit can be just as obsessive and unhealthy as having an eating disorder. And there’s nothing more boring than talking to someone who is on a diet. (Sorry, dieters, but it’s true.)

I’m not sure what the solution is, but perhaps it would be better to focus on giving ourselves permission to enjoy food in addition to loving our body. Because food shouldn’t be the enemy, either.

I don’t do prevention programs for children, so I wasn’t really sure what an age-appropriate intervention would be for an eight-year old. So I just told Sadie that I work with college students with eating disorders, and they spend many years suffering because they want to be thinner. That if she starts worrying about calories now, that’s a long time to spend not being able to enjoy food. So I made a deal with her that we would not talk about getting fat while we were around each other.

She agreed, and we happily ate our pumpkin waffles together. I’m sure it didn’t put an end to her focus on calories and staying skinny, but at least I can hold her accountable when I see her. And she can do the same for me.

Angels and Demons

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spoonflower.com

I thought of something I can say to the part of me that tells me I’m undeserving. In fact, I say it all the time. It’s “Shut up demons! You don’t know me!”

People usually think of that little devil on our shoulder as the part of us that tells us to do something bad, like “Go kill that person!” Plus some less extreme things, like “Call that ball out! You’ll win the game!” From a mental health perspective, the devil tells clients to do things like “Get black out drunk instead of staying in to study. And then miss your therapy session so you don’t have to talk about it.”

Sometimes that little devil will disguise itself as the angel and will try to make us believe that we are doing something good when we are actually hurting ourselves. Things like “There are people starving in the world, and here you are eating all of this food that someone else needs more than you. You really shouldn’t be eating at all.” Those are the most insidious messages of all.

When I was depressed I went around yelling at my demons all the time. They were constantly telling me that I should kill myself for stupid reasons. But I didn’t want to die. I knew it wasn’t coming from me. So I would literally go around the house telling the demons to shut up. Which I found hilarious.

My psychiatrist, on the other hand, did not appreciate my sense of humor. When I told him I had started yelling at my demons, he did that stereotypical psychiatrist thing where he just looked down and wrote something on his legal pad. Probably something like “She’s f@%ing crazy!” But whatever. It worked. All that warrior training paid off.

I was really tired on Sunday and Monday. I had been obsessing about my Halloween party for weeks because I have an anxiety disorder. I am in the midst of the busiest part of the semester and rarely have an hour to myself, unless someone doesn’t show up. I’m playing on two tennis teams and am captaining one of them. And the weekend before I drove 4 hours to watch my beloved UVA team blow another lead to lose the game, which was both tiring and depressing.

So for once, when I needed to sleep all day on Sunday and a good part of the day on Monday, I did so without beating myself up about it. Without trying to will myself to be productive. Without telling myself how pathetic I am for being so tired, when the average human being wouldn’t be. Instead, I tried to take care of myself. I would ask myself things like, “What do you need right now? Are you hungry? Do you need to go back to sleep? Would it help to take Advil? How can I make you feel better?”

Sometimes the little angel on our shoulder tells us not to do bad things. But more often, in my case at least, it encourages me to be more loving to myself. So I’m going to counteract messages about being undeserving with love. And by yelling at my demons.

Declaration of Independence

I am working with a client who was sexually assaulted and is thinking about taking her case to our judicial board. We talked about the levels of awareness that she went through before she could be ready to take this step. How at first she didn’t want to acknowledge what happened. Then she opened up to a few people who felt safe. Now she wants to make sure he understands that what he did was not OK. To force him to think about it the next time. She hopes to eventually share her story at Take Back the Night so that other people can benefit from it.

She knows that there will be people who won’t believe her. Who will blame her for what happened. She prepares herself by reminding herself that as long as she knows what happened, that’s all that counts. But that’s a hard thing to do–to face the judgment within us and around us. It takes a lot of courage to face that kind of scrutiny.

I like to think of this process as a kind of declaration of independence–from our demons, from judgment, from fear. It happens every time someone goes to AA and admits they’re an alcoholic. Every time someone finds the courage to say I have an eating disorder. I struggle with depression. I live in fear. In making this declaration, they take away the power that their condition has to make them feel weak. Defective. Crazy.

To a lesser extent, I think of my blog as a kind of declaration of independence. I’ve tried to hide these things about myself all my life. I don’t want to be held hostage by them anymore. I want to be able to embrace everything that makes me who I am–especially the things that I am ashamed of.

The president of the student organization I advise, Active Minds, told me that he reads my blog, which kind of freaked me out at first. But he thought it was the most powerful way to fight stigma and to let other students know that they are not alone in their struggles with mental illness, which is the primary goal of Active Minds. So he is finding ways to give students the opportunity to make their own public declarations. It is a wonderful feeling to know that this has come out of my willingness to share my vulnerabilities.

I’ve always liked the expression that freedom isn’t free. You have to fight for it. Although blogging has been a surprisingly supportive and positive experience, I am well aware that there will be times when someone will judge me for what I say. I try to prepare myself for it by doing what my client is doing–to remind myself that ultimately, the only person who counts is me. Then I take a deep breath and hit Publish.

Declaration of Independence

Guilt

I talked to my therapist last week. She gave me permission to stop feeling guilty about my sleep cycle. Told me that I have no reason to get up early, so I don’t need to worry about it. That when I have to wake up, I will do so.

It helped some. Today I woke up early for a tennis clinic. But then I took a nap afterwards, which was well-deserved but still somewhat guilt-laden. But I’m writing a blog post now, to prove to my inner critic that I am not completely worthless.

Those quotes about letting go kind of annoy me. If guilt were something I could just let go of, I would have done so long ago. It’s like telling someone who is anorexic to just eat. Put food in your mouth. Chew. Swallow. What’s so hard about that? I envy those people who find it so easy to be free of their demons.

Therapists often ask clients what it is that they fear will happen if they let go. I guess I fear that without guilt, I really will become a terrible person. Someone who doesn’t care if she hurts other people. Someone who is not living her life with integrity. Maybe I’ll go too far in the other direction. I’ve done it before.

In Shame and Guilt, Tangeny and Dearing argue that guilt is a healthy emotion. It let’s you know that you have done something wrong and motivates you to make amends, correct it. When you feel shame, however, you don’t just feel like you’ve done something wrong; you feel like there is something fundamentally wrong with you. You are broken beyond repair. Shame leads people to lash out and project their faults onto others, or to lie and hide.

I guess I am somewhere in-between, because I worry that there is something wrong with me, but I am motivated–determined, even–to become a better person.

My latest strategy for coping with guilt about the past is to tell myself that I don’t have to continue entertaining this memory. I can take it out of the rotation. Throw that record out. Or in more modern terms, remove it from the playlist. I have enough things to feel guilty about in the present without revisiting every mistake I’ve ever made in the past.

For whatever reason, it works. In part because I think it’s funny, imagining myself tossing all these record albums behind me. It doesn’t get rid of all of the guilt, but it creates some space in my head for more guilt-free thoughts. That’s something.

Interventions

I’m not good at confronting people. Which is ironic, because one of the things I do in my job is coach students on how to confront their friends about having an eating disorder. And I think I give pretty good advice, too. But I guess I’m not as brave as these students are.

Because confronting their friend will most likely put a strain on their relationship. It’s rare that the person who is being confronted says, you’re right. I do have a problem and I want to get help. Thank you for saying something. Confronting them may just be one step in a long series of steps toward getting help. It may not get the person into the counseling center right away, but it may plant the seed of recovery in their mind.

I’ve had many clients with eating disorders acknowledge that even though they would have denied having a problem at the time, they still wanted someone to say something about their 30 pound weight loss. And I’ve heard many clients in recovery say that although they were mad at the people who tried to help them at the time, they played an important role in the process of accepting their disorder.

I know all of this, but I’m still afraid to do it. Maybe they’ll be angry and yell at me, and I hate being yelled at. Or maybe something else will happen that will feel terrible, but I can’t put into words what it is that I fear. So I have to think about what day I want to ruin. What day I want to be incapacitated. I haven’t found that day yet. But I need to, because I gave my word that I would say something.

I don’t even have to do it in person, since I live so far away. I just have to make a phone call. And in my defense, I have tried to call a few times, but the whole time I was praying that he wouldn’t answer. Luckily for me, he didn’t. He never answered and never called back, which is unusual. Perhaps he knows why I’m calling, and he doesn’t want to have this conversation, either. Which makes it that much harder to force it to happen.

I ordinarily pride myself on accepting challenges, mental toughness, and doing the right thing. But in this case, nothing has motivated me to move closer to having this conversation. Not prayer, or meditation, or talking my therapist. Not even guilt and shame.

So I thought I’d blog about it and see if that helps. I’ll let you know.