I shook my head to let her know that I understood. It was not such a hard concept to grasp, although I was sure it was going to be hard to challenge thoughts that had been repeated over and over again.
Dr. Serrano pulled out a stack of papers and passed them around the room, instructing each of us to take one sheet. When I received my copy, I looked down and read the title: Self-Esteem Defined.
How ironic that I would be working on self-esteem on my first day in the program. My brain was already fired up about it, and by coincidence, I received a worksheet on the same subject. Self-esteem was a tough topic for me. I always thought that my self-esteem was pretty good, until I realized that I was only pretending. In reality, my self-esteem was never very high. My mind drifted to my three-year-old self, the little girl who thought poorly of herself and her body.
My self-esteem had always been connected to my body in some way. If I was not very good at something, I took it out on myself and automatically thought that it was because of my physical being on the outside. I remember watching television and realizing that all of the women would equate their likeability to their body size, shape, or appearance. If a man did not like a woman, she thought it was because she was ugly. Or fat. Or too tall. It was never because they did not have a connection or that they just did not get along. My brain had been wired to think that my faults always came back to my body.
Besides my physical appearance, I felt as though I was never good at anything I did, or if I was good, I was not good enough. I wanted to be perfect. I wanted to make no mistakes and for everyone to be proud of me. I wanted to be the smartest so my parents could go up to their friends and show me off. I imagined them pointing to me with cheesy grins on their faces, gloating about me and how I did so well. Sometimes they did, at least when they were putting on a show.
At home, it was a different story. My faults were always pointed out and criticized while my accomplishments were minimized. I actually was an intelligent student and I always brought home report cards filled with A's and B's -- except when it came to math. I figured that I was born without the gene that was able to process numbers and calculations. When I advanced to higher levels of math, I could not grasp the concepts like many of the other students. Instead of receiving A's and B's like in the other subjects, I received C's, and even a few D's.
On those report cards, my eyes simply focused on the math grades and failed to notice the others, even though they were very good grades and something to be proud about. My dad pointed out the fact that I was not doing very well in math, failing to even mention the other grades most of the time.
I was stupid. Dumb. A failure.
I learned to ruminate on the more negative aspects and completely ignore the positive. It hurt my self-esteem since the negative completely overruled the positive. Instead of sharing my emotions with someone, anyone, I pushed them aside for another time. Only, that time never came, and so my emotions had built up inside for years. Every negative fact I had heard about myself and my performances were clung to me. I remembered them far more clearly than anything positive mentioned.
By the time my thoughts started to wind down and my writing was completing on the sheet, it was time to share our thoughts with the group.
"Who wants to start?"
I sat in my seat, silently staring at the floor, waiting for someone else to chime in first. I did not particularly want to talk and there was no way I was going first.
"I'll go!" The outgoing personality who spoke to me volunteered to share. I learned that her name was Danielle and her story was very similar to my own. She also never felt good enough and wanted to be perfect at everything she accomplished. I felt comfort in knowing that I was not alone in the struggle to accept myself. Although I knew I had qualities that were great for me, it was not enough, and I saw that in someone else.
By looking at her, I would not have guessed she had self-esteem problems. Just as I judged the doctor based on outside appearances, I had judged her, too, even before the exercise. She looked confident as well, yet it was all a front. I wondered how well I acted in front of other people in order to hide how I was really feeling.
I realized that everyone in group was hiding behind the fake wall of the eating disorder in order to show their fake self-esteem. None of us wanted to show our true selves for fear of rejection and judgment. We all felt so low about ourselves and had tricked everyone around us. It was a connection between us all, yet I knew it would be a great obstacle for me to overcome eventually.
11
You Need Money for That
After two weeks of working hard in the program, fate decided to throw in another problem for me to deal with at the same time. I received a bill in the mail for the first few days of treatment. Since I had no health insurance, my parents were going to have to pay for everything. That meant dipping into my father's retirement fund and cashing in other financial stocks in order to pay for my care. My eyes scanned through the lengthy bill and stopped when it came to the bold, black print, indicating what we owed to the hospital.
$1,000 for three days in the program. 12 hours total. 9 hours of therapy and 3 hours for dinner. I could not believe the outrageous price that had been placed on a treatment plan to help save lives.
Immediately, I felt guilty. Before I started, my parents agreed to pay the amounts due and they knew what the amounts would be. But I only had a vague idea and it was even more shocking when the days were added up and staring at me in large, bold print. I felt guilty that they were going to shell out thousands of dollars just for me, for something that I had brought on myself, any way. Thousands of dollars that could be spent on much more important things were going to be used for my selfish need and me. I did not want to take away their hard-earned money. I felt as though I was not worthy enough of that kind of price tag. I assumed that once my parents saw the numbers adding up, they would pull me out of the program, but would still keep me in long enough to get something out of it.
I was scared to show my mom the bill, so being the clear-and-outgoing-communicator I was, I left the bill in front of her chair on the kitchen table. I did not want to see a freak out reaction if I showed her myself so I avoided the situation altogether and left it for her to read alone.
I did not want to be the cause of any financial problems my parents could run into. They wisely saved their money and planned it out so they could live comfortably after retiring. Because of me, their security would now be tampered with. Their hard work would be dwindled away because of my decisions and actions. I felt selfish for knowing that they would now have to pay for me. Even though it was for something important, a legitimate medical issue, I felt that it was not important enough.
Because the medical issue was an eating disorder, my thoughts screwed around with me and convinced me that an eating disorder was not really a serious medical problem. I did not have cancer or another life threatening disease. I brought on my eating disorder, I caused it. Not only that, but I was an adult. My parents were not legally responsible for me any more but they agreed to pay for my treatment. I thought that I should have been paying my bills and not relying on my parents. I was 19 years old, not a helpless 4 year old who knew nothing about financial responsibilities. My own bank account stored money for me to pay a percentage but my parents had insisted that I needed to save my money for my future.
After being in the program for a while, I was starting to become more comfortable with the people around me and I started to open up a bit. The group knew me on the surface and also knew some underlying issues I kept inside, hidden from everyone else. I was slowly learning how to let others in on my thoughts and showing my real self, something that I had not done too often.
One group in the program was called Interpersonal Therapy and it was based on addressing all of the issues we were having within ourselves and the people around us. I felt that I needed to bring up the subject of the medical bills. I wanted to hear the group’s opinion and see if they agreed wit
h me. Even though I was getting to be more comfortable in the group setting, I still had not started a topic yet. I waited for others to speak first and if I had something to say, I would chime in. None of my issues were the main focus and I was anxious to bring it up in the first place.
"This is IPT...." Another doctor, Dr. Reed, lead the IPT group. She was another young woman like Dr. Serrano who seemed to be very confident in herself and her abilities as a doctor. Her personality was quirky and she enjoyed making jokes. We laughed at her unique facial expressions and sense of humor, a great relief in such an intense setting.
"I heard you all were pretty talkative at dinner, so you guys should be raring to talk in here! Right??"
All of us eyed each other and smirks appeared on everyone's face. Of course, we enjoyed talking at dinner where we were able to freely talk by ourselves, even though some topics were off limits, but therapy was not as enjoyable. No one enjoyed serious talk, especially since it was what we had avoided for years and years. We were able to talk about superficial topics with no problem, yet we were not able to delve into our emotions and let people know how we were really feeling.
Because of this, IPT was sometimes awkward, especially at the beginning of every session. Our heads bowed down and our eyes never left the carpet. We all hoped that someone would talk in order to disrupt the awkward silence that filled the room. Even when there was a discussion going on, many of us were afraid to give our opinions, for fear of being judged. We were all worried about saying something wrong because we were stuck with each other every day. We did not want to hurt anyone’s feelings, even if our thought was truthful and was the right advice.
The session did start with silence, but I chose to do something I had not done before. I spoke up and volunteered to share my story first.
“Erin! What do you have for us today?”
I was not sure what I was doing, I did not know what I was going to say. I was afraid that I was wasting time. What if there was something else that another patient wanted to talk about? My issue could have been so trivial compared to their problem. So I started by saying that I felt stupid by bringing it up in the first place.
Dr. Reed began speaking immediately after I said I felt stupid.
“How can she dispute that thought?”
Almost instantly, the others began to shout out disputations for my thought.
“You’re not wasting our time. It’s why we’re here.”
“Nothing that needs to be talked about here is stupid!”
“We all feel like others are more important. It’s what got us here in the first place.”
They were all very right. The group as a whole was amazing at disputing thoughts, but when it came to our own thoughts, we were horrible. Somehow, we convinced ourselves that the disputations for others were not applicable to our own situations. Everyone else could receive help but us. Everyone else could be happy but us. It was difficult to apply our own advice to ourselves.
After hearing everyone’s thoughts, I continued speaking, without prefacing it by saying I felt stupid. My hands started rubbing together and my foot tapped the ground. I was still hesitant to say anything.
“Well…we got the bill from the hospital today. It’s for $1,000. My parents said that they would pay for treatment, since I don’t have health insurance right now, but I feel really guilty for making them pay. I feel like I’m wasting their money and they shouldn’t have to use their money for me, and I brought all of this on myself anyway. It’s not their problem, it’s mine, and I should pay for it.”
The group thought for a minute. Some of them had been in similar situations and they had to talk through it, as well.
Carrie, an 18-year-old college student, sat across the room from me. She always amazed me with her unique fashion sense and her hairstyles. I was pretty sure that I had not seen her in the same outfit twice. She began to speak.
“I went through this the last time I was in treatment. I was not in school and I was dropped from my parents’ health insurance. They had to pay for me and they kind of struggled, but they always reassured me that they didn’t care what they had to do, that they just wanted to take care of me. I’m sure your parents think the same way. Your parents love you and just want you to get better.”
I smiled and accepted her advice. My thoughts tried to dispute hers, but I tried to ignore them and focus on what she said.
To my surprise, a few others said the same thing, that my parents loved me and I should not worry about it. They mentioned that money would be lost but that I was much more important than money. I tried to accept that I ultimately was more important. Sometimes it seemed as though money was the most important thing in the world, but it was going to take a while for it to set in.
After everyone spoke and let me know what they thought about the situation, Dr. Reed asked the group a question.
“Erin doesn’t think an eating disorder isn’t as dangerous, say, as cancer. Can anyone explain why it is life threatening?”
We were taught the risks of eating disorders quite a few times. Anytime anyone said that their eating disorder was not serious, the discussion of how much of an impact it plays in our lives popped up. Dr. Reed wanted our brains to be seared with the information so we would never forget the dangers of eating disorders.
“Infertility.”
“Loss of bone mass.”
“Dehydration.”
“Dry skin and hair.”
“Anemia.”
“Muscle wasting.”
The room went silent as we all contemplated the risks involved.
“What about death?” Dr. Reed pointed out the most dangerous consequence of all, leaving us with our eyes widened with nothing to say. “Do you ever think about that? It’s a possibility. Eating disorders have the highest mortality rate of any psychiatric illness. I want you all to write that down so you don’t forget.”
I jotted down the statement. Death was such a strong word and I never truly thought about it as a consequence before.
Eating disorders were deadly and I thought that I was safe from the risk. I felt guilty about my parents needing to pay medical bills, but it was a life-threatening illness after all. If I was diagnosed with cancer, I would not have felt as guilty, but the stigma of mental illnesses made me feel as if it was my entire fault. Ultimately, I knew that I did not choose to have an eating disorder, yet I somehow figured that it would be easy to overcome because it was all in my head. But it was not.
12
Numbers Do Matter
I first entered the Intensive Outpatient Program just slightly underweight for my age and height and I knew that I would need to gain a few pounds in order to reach my goal weight. For patients who needed to gain weight, the program calculated goal weights based on height. Personally, I was not too happy with their calculation, and I knew the others were not too excited about it, either. I did not know of any patients who would willingly allow themselves to gain weight and be completely content with it. I thought that my goal weight was far too much, but I knew that it was only the eating disorder telling me that. Realistically, I had no idea how much I should have weighed. Their calculation for my goal weight was actually a healthy number for my height but my distorted thinking thought otherwise. For such a long time, my brain had been processing various numbers and trying to rationalize unhealthy low weights that I thought were all right for my body. Logically, I knew that the added weight would not kill me, but the journey to reach it was not an easy one.
We were all advised multiple times that the numbers on the scale did not matter. We were more than numbers flashing on the screen. We were people with depth and character and personalities. Numbers were not important. That is, unless weight gain was required.
Since I was expected to make the number on the scale increase every time I hopped on it, I was always torn on the results. Half of my head sided with the eating disorder and I hoped that the number would go down, giving me that rush of knowing that I ha
d lost weight. The other half of my head sided with my recovery self and hoped that the number would budge up just a little bit, moving me closer to my goal weight, leaving less weight for me to gain.
I dreaded stepping on the hospital scale twice per week. Even though my weight was supposed to get higher, the thought of my body adding extra mass was horrifying to me. No matter what the outcome, though, the number always affected my mood.
I remember specifically one day during the program. The weather was unseasonably warm and I drove to the hospital with my car windows down and the music blaring through my speakers. I was in a great mood for no apparent reason. And then I remembered that I was to be weighed that day. My thoughts started arguing back and forth in my head as I anxiously awaited my turn to step on the scale. Sometimes, I was urged to turn my back to the scale in case I did gain weight, but I always wanted to know the exact number. The number was important. It gave me a sense of control, regardless of which way it moved. On good days, my mood would crash in a split second if that number increased. It did not matter how I was feeling before my eyes saw the outcome, it only mattered that I did, in fact, gain the weight. No matter how little, I swore that I could feel the extra ounces on my body and my clothes felt tighter. My jeans felt as though they shrunk a few sizes and my shirt felt snug around my arms.
In contrast, on days when the number went down, my mood skyrocketed and I suddenly became ecstatic. My eating disorder took control and made me feel like I accomplished a task, even though it was going against the road to recovery. I felt more powerful and I was more satisfied with my body.
We always knew when someone's weigh-in was good or bad. Our faces told everything, no words needed to be said. We never had to ask any questions because we all knew the feeling. The worst days were when we all were disappointed about our weights. Some were disappointed for weight gain and some for weight loss. But on those days, it took a lot of strength for us to participate in groups.
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