TREATMENT WITH ASTERISKS

Free again! I was discharged from hospital yesterday after spending six weeks in a treatment program for people with eating disorders. It’s hard to know if it made a difference. Already this morning I’m restricting food again and obsessing over what my exercise will be. The habits of the disorder are so entrenched that it almost seems foolish to think a month and a half of interruption can have substantial impact. There’s deeper work to be done.

“Can’t you just eat more?” I’ve had that question posed by my mother and by my best friend.

Others have said, “But you always eat when we go out.” True. The eating disorder likes to be secretive. It’s my own thing. I do it when no one else is around. It’s why I turn down a lot of dinners. (Being vegetarian makes for a surface excuse, no questions asked. I don’t know if it was just a coincidence, but at one point during my hospitalization, six out of seven patients on the unit were vegan or vegetarian.)

Even during my stay, I was straying from program whenever I could. I got daily passes to go home and, instead of taking the bus to and from as directed, I’d walk the three miles at a brisk pace, passing other pedestrians at every opportunity. While the program required three meals and three snacks per day, I’d skip the snacks while at home and reduce my meal. I figured two full meals and two snacks represented enough progress. And enough calories.

I had longer home passes on weekends and, while exercise was forbidden—full symptom interruption, they called it—I managed to fit in three moderate exercise sessions per week. This was as radical a change as I could tolerate. I told myself I was making the program my own.

Really, I lied. Just like an addict. After every pass, I said I had no struggles. I said I ate according to my meal plan. I told them I did not exercise. I had to lie so I’d keep getting passes. The daily trips off the ward were what kept my sanity. I told them what they wanted to hear. I left as a success story.

So what was the point of it all? Why did I give up six weeks of freedom? In spite of my cheating, my body took in more food and more variety. To a regular person, eating peanut butter or mayonnaise would not be a victory, but higher fat foods were real challenges. Heck, even the amount of water they made me drink was a challenge. My exercise was severely reduced. The miracle is that I didn’t gain weight even though that was my constant fear.

What most people focus on is the outward signs of the eating disorder—amount of food intake, bingeing, purging and exercise. These are clear things to follow when assessing progress. But if it were simply about eating more and exercising less, treatment would be relatively simple. What many people overlook are the psychological reasons for why the eating disorder developed and continues to be fiercely maintained. Issues like self-esteem, perfectionism, betrayal, abuse and neglect come into play. The eating disorder represents control, self-discipline, even comfort. As my eating disorder has gone on for decades, it’s far trickier work uncovering the roots of it so that real, lasting change can occur.

I may be out of hospital but more work remains, on my own and with professional support. Nasty bugger, this eating disorder.

A BELATED AFFIRMATION

There are days when I wake up in my hospital bed and I still wonder if I belong here. For the past five weeks I’ve been in treatment for an eating disorder, an affliction I’ve struggled to acknowledge within myself and I’ve struggled even more to get others to understand.

Each and every time I’ve dared to disclose to someone, the response is quick, a snap judgment. “You don’t have an eating disorder.” 

I don’t feel like having to prove my point.

It’s true that I don’t look the part. I’m male, I’m in my fifties and I’m not rail thin. I even sport some pesky love handles. 

Twenty-four years ago, I dared raise the possibility of an eating disorder with my family doctor, a compassionate gay man whom I assumed would have many patients with low self-image issues, disordered eating and excessive exercise regimens. I had a great deal of angst in the build up to telling him what I thought I might have. He dismissed it as if to reassure me. It only made me feel more alienated. If I didn’t have an eating disorder, then how could I get help? I was starving myself for huge chunks of the day, obsessing over fat content in foods and exercising through injuries, feeling trapped by my workout routines. If I missed a day, the belly would never be tamed.

There were ebbs and flows to my disorder. In relationships, I’d sometimes let up. I’d eat ice cream and pizza with my boyfriend, feeling like a sinner but happy to have a partner in crime. Whenever I wasn’t with my boyfriend, the food restricting would kick back into high gear. Aside from my non-skinny appearance, a big reason so many people haven’t thought I had an eating disorder is because the key behaviors happen when alone. It’s a clandestine disease. When my eating disorder ruled me, I didn’t want to be caught. I didn’t want anyone telling me to change. My eating disorder brought a twisted sense of comfort. It represented control and self-discipline when I felt powerless in many areas of my life. 

You don’t have an eating disorder.

I heard it so many times, I felt I couldn’t get help. I was embarrassed to bring it up. I didn’t want to be invalidated again.

Even when I was hospitalized for depression five years ago, refused food and obsessively exercised in my hospital gown on an elliptical, professional staff failed to recognize my ED behaviors. It took a second psychiatric hospitalization for a psychiatrist and dieticians to piece things together after the nurses complained about my resistant behaviors to eating meals and to eating with the other patients. I finally got a referral to an eating disorder program. 

There are no elliptical machines during my current hospital stay.

I’ve since been assessed by doctors several times. Each time, I hear a common refrain in my head: You don’t have an eating disorder. Each time, I am both disheartened and relieved to hear the doctors confirm the diagnosis. Yes, I have an eating disorder.

As I sit in groups with other patients with eating disorders, I nod with them. They say the same things I think. They nod when I speak. By golly, I belong. 

When I awaken at 5 a.m., I can’t help but wonder if much of my life would be different if I’d gotten help twenty-four years ago. With earlier intervention, maybe I would have overcome the insecurities about my body and chipped away at all the self-hate. 

In my hospital room, I tell myself it’s not too late. I want to believe this old dog can learn a new way of living and can be more forgiving of all the imperfections I obsess over. This cycle of treatment ends, however, in nine days and I know I’m nowhere near real change. Many of my co-patients have had multiple hospital admissions. Is it the program that’s unsuccessful or is the eating disorder just too strong? Maybe it’s both.

I’m lucky to have more counseling and another treatment program on the horizon. Another team of professionals is recommending I stay three months in a group home for people with eating disorders. 

Me? I may not look the part but suddenly the professionals won’t let me slip through the cracks. My behaviors still feel entrenched but I have some hope for change. I want this hospital stay to be the start of a different way of living.