Lungs and hips are equally overrated

Yesterday I had a panic attack so intense that my lips actually took on a slightly purple hue. (I wasn't breathing enough. Holding your breath and barely taking in oxygen will do that.) The real anxiety set in after I noticed this chromatic conundrum, meaning that any real "breathing" had stopped well before I even noticed the panic attack. This panic attack followed hard upon the heels of one from the previous day that was set off by something along the lines of a mess on the floor and husbands who don't know how to clean up the kitchen after they make lunch for themselves, good gravy. This afternoon I was struck with an ongoing wave of nausea so bizarre, coupled with a dull headachey feeling, that I was sure I was either pregnant (am not), or in the early throes of a Migraine of the Century (I wasn't). The nausea and headache were products of wait for it... a to-that-point-unidentified panic attack.

The only thing surer than panic attacks that come in little clusterfucks is this: Around these same days (usually, hem hem, hormonal ones) I cannot get over just how "fat" I am. I walk around avoiding reflective surfaces, entranced by the jiggle and the bounce. I stand or sit perfectly placidly, then suddenly realize that my skin must be literally about to pop open. I feel so intensely uncomfortable and disgusted.

I am never shocked, when I step on the crappy drugstore scale that hides under our bed, to see that the all-hallowed Number hasn't shot up. It's usually quite the same, if not a pound or two lower than it was a week previous (which is "the same" for all intents and purposes). Having been in the same five-pound swing zone for the past four and a half years, I know what's going to pop up on the digital display. Regardless of how accurate the scale's set point is (it weighs our ten-pound weights as 8.8, for example), the point is this: My weight does exactly it's supposed to. It stays basically the same. This is why we have a scale in the first place: So I can check in with reality from time to time to verify that I have not, in fact, gained or lost any weight (because the funhouse mirror can squeeze both ways).

It should be a given that, when I start getting these clusters of panic attacks, I must immediately stop looking in the mirror, just for a few days. I understand why the one event is comorbid, so to speak, with the other. My issue is that, hormones aside, I never see this coming, don't know what triggers these half-week-long episodes, and would prefer to REMEMBER for a change next month.

You know. So I can write "Breathe" and "Wear Sweats" and "Don't eat frosting right out of the can" on my To-Do list. Anyone want to send me an email about that in three weeks or so? That would be greeeat.

This nothing's more than matter.

There's rosemary, that's for remembrance; pray,
love, remember: and there is pansies. that's for thoughts.


Downtown Manhattan



Peter Pan at Carl Schurz Park, East End Avenue and East 86th Street


Bethesda Fountain, Central Park at 72nd Street

Well, you know. As Jon Stewart said, you can't beat that view.

The Thought Process: Redux

Every day, multiple times a day, I have to reason with myself why I should or should not look/feel the way I do. Every day, multiple times a day, for instance, I have to make the choice to eat or not to eat; to purge or not to purge; and to attack myself or to let it slide. Every day, from the minute I wake up until the minute I finally (sometimes mercifully) fall asleep, I have to wrestle with a dichotomy of thought along these lines:

A: "I can get down to [blank] pounds/size again. I can do it in a healthy way this time; I can do it for good."
B: "No - I've been at [blank] pounds/size, give or take [medically reasonable amount of lbs./sizes], for the past four years, while doing my damndest to follow the advice of ED treatment professionals. This is where my body wants to be."
A: "I can do it: Cut down to [blank] for breakfast, and [blank] for lunch and dinner. It won't be that hard. I'll take multivitamins and calcium this time; it will be healthier."
B: "No - all these things will happen, instead of losing [blank] pounds: My skin will get dry. My hair will stop growing. I will lose my energy. I will further jeopardize my fertility. I will become boring and obsessed again. I will damage my marriage and relationships. I will build debt on food and diet pills. I know, because I've done it before."
A: "But you don't have to look like this/weigh this. Even the charts say you can be [blank] sizes/pounds lower than you are now and still be 'healthy.' Why not just look like/weigh that? What's wrong with you that you can't stop at the minimum?"
B: "OMG, STFU."

I think in Internet acronyms.

No one in the eating disorders world speaks in hard and fast rules or timelines. You can't say, "After five years of intensive psych and medical treatment and nutritional counseling, Jane Doe will be cured of bulimia or anorexia." You can get your weight as firmly in a stable range as you like, but that doesn't mean the disease itself stops chewing on your brain. I don't know why this is so shocking to some people, including ED patients (and me, of course). You can't any more accurately say, "After five rounds of chemo and radiation, Jane Doe will be cured of non-Hodgkin's lymphoma." More relevantly, you also can't say, "After five years of intensive treatment, John Doe will be cured of major depressive disorder," or "borderline personality disorder." It's not done with more mental illnesses/disorders, nor with most addictions. No one who knows the bare minimum of information expects it.*

And yet, here I am, among millions, wondering where the hell is my cure and what the hell am I doing to avoid it? Five years, two months and two weeks ago I started clinic treatment. (Five years, six months and two weeks ago I started individual counseling.) I figured by this point, surely, I'd be fine. Or, if not fine, then not absorbed in the ED thought process at quite such a frequency. I try my best - most of the time - but I am NOT finding the ease of "act as if" to be a naturally occurring phenomenon for me. Never did, no matter my level of counseling or medication. The pitch and frequency remains just about steady as it was, maybe, four years ago. Perhaps being a facts-oriented personality, rather than some more open-minded type, hinders my conception of the process. However, I can tell you that no matter how much I "act as if" I am secretly thinking as if NOT.

It's frustrating.

In the ED world five years is not necessarily a long time, especially when you consider that that's when treatment actually begins. My disordered behaviors started closer to twelve years ago, and those "behaviors" matched up and surpassed clinical definitions closer to seven years ago. "They" say that eating disorders are lifestyles that much resemble blood stains: The longer it's there, the better chance that it's never going away completely. I don't believe that. I won't. But that doesn't minimize my frustration and anger at not having an "off" switch for this thing, let alone a general time frame. I can't never eat again (without dying), and I can't never to look at or feel my body again (without bizarre consequences, such as really, really awful makeup and a wardrobe consisting of mumus). There isn't a precise cut-off date, like enrolling for classes each semester.

Let's just say that when President Bush suddenly came up with a timeline for withdrawl from Iraqi cities? I was a little jealous.**



* Except the recovering alcoholic father of a recovering alcoholic/fellow bulimia patient five years ago. He was curious why she was still in our treatment program after 28 days. After all, he reasoned, alcohol rehab had done the trick in that timeframe. Why shouldn't an eating disorder clinic work the same way?

** Considering it used to be tantamount to "setting a date for failure."

Eating Disorders in the Media: The Little Misconception That Could

BusinessWeek Debate Room: Anorexia: A Media-Borne Illness?

Carrie already posted about it, and I reeeeally wanted to avoid it, because I knew it was going to piss me off. (And, atypically, I was not in a mood to be willfully pissed off today. It's got to happen at least once in my life, right?)

But I then caved. I still wasn't going to write about it after reading the piece, because, what else is there to say about such idiocy? The article itself isn't worth talking about, except for the fact that it got published at all. The guy they have writing the "Pro" side of the argument, Matthew Lawyue, is a reporting intern for BusinessWeek. Intern. INTERN. The gal (Oriana Schwindt) on the "Con" end (astutely titled, "Blame the Eaters") is a recent graduate. In journalism. NOT PSYCHOLOGY. Or NUTRITION. "She writes for the Innovation and Managing channels of BusinessWeek.com." Yes, she's very innovative: They switched it up. Have a female excoriate people with eating disorders, and a male stand up for them. I get that these are "kids" trying to launch their career, get their foot in the door, get their name out there, etc. and so forth, so after making some scorching comments in my head, I'll give them a pass, this once. Plus, Carrie already got 'em.

But I then read the comments and I said to myself: "Self," pausing to appreciate that I'm so terribly original, "We have to write about this one." "You're right, Self," I continued, undaunted by the cliché, "Someone has to point out the utter futility of improving the human race, and thus explain the title of this blog*." "Let's get to it." "Yes, let's."

Most of the comments are insightful and factually correct. The comments by parents of ED patients are heartbreaking. I wish I could find the mother of the 11-year-old boy (anorexic) and give her a long hug. But there are also idiots in full bloom. The one that provoked my Self's realization that We must write:

If eating disorders are simply inherited diseases, why is their occurrence so great in actresses and other women in the public eye --Terri Hatcher, Calista Flockhart, Princess Diana? And why was there no anorexia or bulimia problem in the 1940s and 1950s, when being beautiful wasn't all about being thin? And why does anorexia suddenly become a problem when people in the developing world get their first access to U.S. television shows? Oh, right, they must have experienced a collective genetic mutation that prompted them to get eating disorders in unison.

-- RR, Nobel Prize winner for Psychology and Logic.

A) Eating disorders have been around for a long, loooooong time. As another commenter points out, at LEAST since the 1600's. Only recently (fluctuating since about 1920, actually, RR) has extreme thinness been obsessed over in the media at large. Meanwhile, if you do something as easy as read Jane Fonda's autobiography, you will learn that anorexia and bulimia didn't go anywhere during those idyllic decades you cite.

B) No one is saying that EDs are "simply" inherited - only that there is a genetic COMPONENT. Has it occurred to you that eating disorders, like other mental illnesses, can be tripped by specific environmental triggers? Certainly Princess Diana, suddenly thrust into a pressure cooker of public attention and criticism, is more at risk than her imaginary/hypothetical identical twin (for genetic similarity purposes, you see) who remains shrouded away from public scrutiny? As we like to say in the ED world, genetics loads the gun and environment pulls the trigger. (Oh look - Harriet, right below RR, uses that very phrase.)

And above RR, joemama makes the astoundingly astute observation that most women in New York look "chubby" rather than anorexic. Really? REALLY? *God.*

Okay, I think I'm sufficiently pissed off and dejected to carry me the whole weekend. See you on the other side.

* cyn·i·cal /ˈsɪnɪkəl/ –adjective: 3. bitterly or sneeringly distrustful, contemptuous, or pessimistic. ... Sounds about right.

Because we all know who the victims are here: the companies.

Eating-Disorder Class Actions Get Judge's Go-Ahead
Mary Pat Gallagher
New Jersey Law Journal
August 12, 2008

Since I can't really bring myself to total up the amount of money I've cost my parents and myself trying to "just get over it already," I viewed this article with a mix of hope and resignation. Relatively speaking, my ED tag isn't even that pricey (no long or repeated in-patient stays). Over the course of 6+ years, though, it's hard to think about where all that money coulda woulda shoulda gone.

To summarize, some parents are suing BlueCross BlueShield of New Jersey (hey! that might be relevant to me in 2 years! I'd better read this!) for coverage of their daughters' eating disorders as biologically based illnesses. However,

"In a ruling released last week, [Judge] Hochberg refused to dismiss the case or abstain from decision[.]"

Yay! Oh, wait:

"[B]ut she threw out a significant chunk of the litigation."

Hm. Which part, I wonder?

"The result was to knock out those plaintiffs' claims under the Mental Health Parity Law and the Consumer Fraud Act, along with common-law claims for breach of contract, breach of implied duty of good faith and fair dealing, misrepresentation, unjust enrichment and tortious interference with contract. They are left only with their claims under ERISA, which does not afford a jury trial and often requires review under an arbitrary and capricious standard.

"On the other hand, the plaintiffs insured under policies not subject to ERISA can go forward with most of their claims. It is not clear, however, whether they can assert a claim under the Mental Health Parity Law. Hochberg left undecided the novel question of whether there exists an implied private right of action under the 1999 law."

BC/BS (and other insurance co.'s, historically, won't pay, which means (intuitively, but maybe not in legalese) that BC/BS thinks that eating disorders aren't "real" diseases. Thanks, Insurance Industry. You've got your priorities really straight. Next you'll have Bill O'Reilly in court for you, testifying how he doesn't want his premiums to go up because of some rich, white teenager's "choice." Speaking from a standpoint of total ignorance about the actual legal angle of this, I'd just like to say that an insurance policy not covering mental health benefits, including eating disorder treatment, has always seemed like "breach of implied duty of good faith and fair dealing" to me. And speaking from that same perspective, "arbitrary and capricious standard" doesn't sound... um... hopeful. Yeah. But if you ask me, however, what the above paragraphs *actually* mean, I will stare at you with a glassy look in my eyes, while secretly thinking about Alexander Skarsgard.

Mmmmmmm. Sweeeedes. Mmmmmm.

And one last thing, about one of the statements made by a lawyer for the "defendant" [i.e., bloated corporate machine]: "He emphasizes that the company did not deny coverage and that the plaintiffs seek unlimited coverage, beyond what the policy provides."

Dear Mister Lawyer Person: I may deal with a different state plan of BC/BS, but under my plan - all my plans ever with BC/BS - I have never been given ANY coverage for eating disorder-related costs. My doctors have had to jump through hoops so EKGs would be covered, of all things. We won't even get started on the lack of therapy reimbursement or the laughable response my parents got when submitting for outpatient benefits a few years ago. However, HAD you paid, you might have avoided, by this point, quite a bit of pharmaceutical costs from THIS particular account number, which I'm sure have run way up for you, being that I've never been prescribed a generic. You know. For my "depression." Not to the "eating disorder." For the "depression." For which you "offer [a pittance of] coverage." Ha. Ha ha ha. That's all I have to say about that.

For some general context, here's a good two-liner:

"Pending legislation, S-607/A-2077, would eliminate disparate treatment for nonbiologically based mental illness. A similar bill in the last legislative session passed the Senate and two Assembly committees but was never brought to a vote in the Assembly."

"Never brought to a vote" sums it up nicely, I think.

This also sums it up nicely:

Mmmmmmm.