From Both Sides of the Couch

A therapist reflects on her time with patients, and her time as a patient.

Is There No End In Sight?: Sharing a Struggle of My Own

A departure from my typical format to relate an onging battle that's all mine.

     I'm departing from my usual format of writing about my point of view and my patients to write about myself and a slip, a fall, a lapse—whatever you want to call it—I'm having for the first time in a year.

     "When we first started working together you said to me, I'm an anorexic and I'll always be an anorexic." Dr. Adena* reminded me. Dr. Adena and I have been working together for over six years. She has seen me through many slips, falls and relapses of my anorexia, the most recent ending a year ago. Although last spring I barely avoided hospitalization on an eating disorder unit, I was  medically hospitalized, which is what opened my eyes to the gravity of my situation. After a brief stay in the hospital, I was able to gradually increase my intake and gain the needed weight.
     What I didn't expect was for my body to enter menopause and for my weight to shoot up past where I had always been able to maintain it. I had always sworn I wouldn't be one of those women who gained the menopausal ten to fifteen pounds. But here I was. I felt out of control, tremendously anxious, and very fat.
     I tolerated this new and strange body for a year with the help of Dr. Adena and my nutritionist Miranda.* At one level I knew if I started restricting and losing weight, I ran the risk of losing all that I had worked so hard for; my job, my burgeoning writing career, my new relationships. On another level I knew from experience, from my relapse last year that as my weight decreased, my ability to concentrate and focus declined as well. But I held onto magical thinking that this time would be different; I would be able to stay skinny and function at my usual full steam ahead mode.
     Several weeks ago, I sat in Dr. Adena's office and sobbed continuously, "I just want to be thin." That declaration ringing in my ears, I went home and skipped dinner. Additionally, my eleven hour work days plus an hour commute each way, made it easy for me to rationalize a level of exhaustion that justified walking in my apartment door, feeding my cat, taking my meds and falling into bed—without dinner.
     I began cutting calories on other meals, purging using methods other than vomiting, weighing myself every day. I don't have a scale so I use the scale in our building's locker room, off the gym. When I was not entrenched in my eating disorder, I could go for months without knowing my weight.
As the numbers on the scale decreased, as I fit into clothes I had not been able to for months, the high of the anorexia took over. My hunger cues disappeared quickly and I restricted even more.
     One night I was experiencing chest pains during my session with Dr. Adena. I had these before and I attributed them to anxiety over hiding the restricting from her. I knew if I told her what I was doing she would not be happy and a protracted discussion would ensue from the confession.
     When I got home that night, the chest pains intensified. I knew that my heart could possibly be affected from the restricting and the purging behaviors. I wasn't a kid anymore with a young heart —my heart has been through twenty-five years of on and off again abuse. I was afraid of waking up in the middle of the night with a heart attack and not having enough time to call 911 and get to a hospital. I didn't want to die.
     I took a cab to the emergency room and had an EKG, an x-ray of my chest, and bloodwork to determine if my heart had been damaged. Everything came back normal and I was extremely relieved. For reasons that remain elusive, even to me, I did not stop the anorexic behaviors.
     I related the series of events to Dr. Adena during our next session, several days later. "What's the plan?" she asked simply.
     "I'm seeing Miranda tomorrow," I answered.
     "So you and her will put together a healthy meal plan?"
     I nodded.
     I met with Miranda and we did just that, but I'm only half following it and I'm still purging occasionally.
     Dr. Adena and Miranda say that I have to trust them as far as my body image is concerned because mine remains distorted. I fight with them every chance I get; they say I look good now, they remind me that last year when I was at the weight I consider ideal, I appeared ten years older than my age. I do get compliments from friends and co-workers that I am thin, slender. But I don't see it. I glance in the mirror and see a belly that looks six months pregnant.
    What drives this self-destructive force within me? Why, after the fear of dying from a heart attack do I persist in these self-defeating behaviors?
     I don't know.I don't have an answer, or the answer. All I know is that it's connected to my extreme hatred of myself, which is something I continue to explore in therapy.

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 * Names have been changed

Gerri Luce is a licensed clinical social worker who publishes under a pseudonym.

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