I was petrified. I didn’t think I was thin enough to go to treatment. I thought I’d be the biggest girl there and that everyone would think I was too fat to be there. I told my treatment team that I’d only go to treatment if I could finish my semester at grad school AND go to California for it. I didn’t think they’d agree. Joke was on me: they did.
On June 9, 2010 I got on a plane by myself and flew out to California to a residential treatment center. I quickly learned that residential treatment had women of all sizes and diagnoses. And while, yes, some women were thinner than I was, there were also women of all different sizes. I started to realize that size didn’t matter AT ALL when a person has an eating disorder. We all had the same unhealthy relationship with food and we all were putting our bodies in terrible danger. We just dealt with our relationship with food differently: some of us restricted our intake, some ate only ‘clean’ or ‘healthy’ foods, some exercised obsessively, some binged and purged, some only binged, some did a mix of many different behaviors.
When I sat down at the dinner table that first night in California—to clarify, this was my first time sitting at a dinner table for an actual meal in over a decade– I was expected to eat 50% of my meal. The next day I would be expected to eat 75% of my meal. The third day onward I had to eat 100%. Depending on how much of my meal I did not eat, I would be expected to drink 1-2 Ensure Plus supplements.
When you begin the refeeding process they start you off at a very low intake. The body can react in very odd ways to refeeding, so they gradually build you up. For instance, during refeeding my phosphate levels dropped below a healthy level. Other women I was with developed edema. On that First night, I ate just enough so that I wouldn’t have to drink a supplement. My stomach was in so much pain from eating real food that I just curled up in a ball and cried on the couch. The nurse kept telling me to sit up straight, she said it would help with digestion. Sitting up straight was not comforting to me. Staff eventually began to redirect my behaviors of curling up by prompting me with the word, ‘Pretzel’ (meaning that I was curling up in to a position that resembled a pretzel, something that is a bit like curling up in fetal position).
The other women in treatment were so nice and supportive. They tried to help me distract my mind from how physically uncomfortable I felt by inviting me to do different crafts with them: making bracelets, making collages, and just talking to me and asking me questions about myself and the east coast.
The Inside Scoop on Residential Treatment
I had read books and heard the horror stories about treatment, but I honestly didn’t know what to actually expect. In treatment, they lock up all of your shower items and other things that they refer to as ‘sharps’ like mouth wash containing alcohol, nail clippers, hair clips, floss, nail polish, etc. The purpose behind this was to prevent women from self-harming. They kept our bathrooms locked except during shower time, which occurred one hour before bed or one hour before breakfast. We could only look in the mirror in the time we were allowed in our bathrooms when we had to shower and get ready for the day or for bed. If we had to use the bathroom during the day we had to ask for permission and go about our business with the door left ajar. A counselor had to both check and flush the toilet for us. It was very embarrassing, but quite a reality check.
As we proved ourselves to our treatment team [a therapist, dietician, and psychiatrist] we’d be allowed to go in to the bathroom on our own unless it was after meal time. If it was after meal time, we could still have the door shut, but we’d have to count or sing. This is not as easy as it may sound!
They based our meal plans on exchanges, rather than calories. So we’d have x amount of grains, x amount of fat, x amount of protein, x amount of vegetable or fruit. Every other week we went on a meal challenge, essentially a trip to a restaurant. On the opposite week, our challenge would be to eat a dessert. We had to choose our meals which was incredibly scary because it was doing something that you had told yourself for so long was not okay, because it meant you were choosing food and accepting that you would eat it. We also had to be sure to mix it up so as not to develop any new safe foods or meal rituals. I was continuously redirected during meals if I tried to break a sandwich apart. I NEVER bit in to anything and I was forced to change this habit. Other food rituals people have can be chewing very slowly, taking very small bites, eating one food group at a time…to be honest, some of the things treatment centers deem as food rituals could be something very normal to any given person, eating disordered or not, so it could get confusing. Sometimes we literally had no idea we were doing something disordered.
Light exercise would slowly be incorporated in to our treatment plan when our vitals (blood pressure, heart rate, weight gain), a decrease in ritualistic behaviors, and our nutritionist deemed us ready. I was finally granted exercise my last week in residential. They went for leisurely walks on the beach for exercise or did yoga. Did I mention I was in California? Gaining the privilege of going for a walk on a beach in CA was extremely exciting for me and I was rather disappointed that I only got to do it twice.
They took our cell phones and we were only allowed 40 minutes of phone calls a week from a house phone. We were also only allowed to use our laptops to check our email for 30 minutes on Saturdays. This was hard for a lot of us for different reasons, some women had young children waiting for them at home. For me, I was across the country, so I couldn’t see my family during family weekend or during visiting hours. It was difficult to only be able to communicate with my family by phone for a limited amount of time. We couldn’t read magazines or watch tv. We could only watch movies that had been pre-approved as non-triggering by staff. You get to a point in treatment where you begin to wonder if there is anything that ISN’T going to trigger at least one individual. We got to go on outings on Wednesdays and Saturdays, which we chose as a group. One outing was typically to Target, where we were able to purchase things like nail polish or shampoo or notebooks or other things we might need or use as activities. The other was a fun trip like going to the beach or a bookstore or to a nail salon.
Before each meal we had to rate our hunger on a scale from 1-10 and say an affirmation. After each meal we had to rate our fullness. A typical day was: breakfast, group, snack, exercise for those allowed, lunch, group, quiet time, dinner, group, free time, snack, bed. We had groups such as DBT [my favorite, it presented me with the ability to reframe my thoughts and an array of healthy coping skills that I still use it to this day], CBT [My least favorite], an open therapy group, Art therapy, Nutrition, Spirituality, Mindfulness, etc. We were weighed every morning in a Johnny, and we had to do a check to prove we weren’t wearing anything under the Johnny. We were never allowed to know our weight.
I met some of the most amazing women there and I will always remember them and cherish our laughter and our tears and the amazing support we were able to give one another. I had never been around such supportive people who also understood just how I was feeling. I also will credit my therapist Nancy, to this day, for giving me such a reality check and helping me explore so many aspects of the disorder.
Going Home and Relapse (Trigger Warning)
When I went home [insurance had kicked me out before I even reached my goal weight, My eating disorder was, unfortunately, very pleased by this] I relapsed VERY quickly. I wound up going to 2 different treatment [resulting in a total of 6 residential stays, which just shows you how difficult it can be to recover] centers over the next 2 years. This time, I stayed on the East Coast. The second center I went to after my initial stay in California was just outside of Boston. I stayed there twice and, while I met my best friend in my time at this particular treatment center, I believe this to be the worst treatment center I was in. They made me feel like I WAS my eating disorder, like I was bad. I was sent home for 24 hours in my first week there because I was struggling to finish my meals in the allotted 30 minutes. I had to write a letter stating why I believed I deserved to stay in front of my case manager, the therapist, my father, and the program director. They let me stay, but they later kicked me out of their day program for losing 1 pound. For some reason they took me back a month later with a very strict contract. I had to eat 100% of my meals all within the allotted time and if one bite was left when the timer went off I was out. I wasn’t even allowed the option to drink an entire ensure if I left one bite of my meal due to not being able to finish it all in 30 minutes. The other women in the program were allowed to have a supplement [and often refused] if they did not finish in time. I felt this was very unfair and I think it made me go in to a sort of fake recovery, for example: I wanted recovery so badly that I basically forced food down my throat. I even choked once in attempt to beat the clock. I was later kicked out of the day program, again, for losing weight. I believe this treatment center cared more about success stories than they did with helping people who were truly struggling, however, I know others walked out of there with more positive memories, so maybe I just felt bullied by the staff. Who knows. I did, however, meet many supportive women whom I still call friends in my time there.
My final treatment program was located in Cambridge, MA. This was the least structured program I had attended and, by far, had the worst food and was the least aesthetically appealing. Montecatini [the treatment center in California] and the first Boston treatment center were both in beautiful houses. This treatment center looked like a dorm. It also had more patients than either of the other programs. It could get very overwhelming, with so many people and I knew so much about DBT, CBT, and nutrition at this point that I honestly think I just went there to finish up my personal therapy and gain structured eating.
While in the day program in Cambridge, I learned that my [now ex] boyfriend had begun using heroin, had been caught buying a large amount of it, would be going to court ordered rehab for a year, and that he had been cheating on me with his ex girlfriend on and off for quite some time. I dealt with the breakup and moved back to MA from NY officially. We had been together for 6 years and I foolishly thought I was going to marry him. I was beyond angry, very depressed, embarrassed, ashamed, and my trust was completely shot. Some people deal with these situations by overeating, I just lose my appetite. I was sent back up to residential treatment from the day program and was put in a structured setting where I was forced to eat. I am very grateful to have had this support at this point in my life. However, since my control over food was gone, I began taking my frustration and anger out in other ways. I’d scratch my skin raw because I was used to restricting my food so as to avoid my emotions or to have control over something. I tended to feel like I had to hurt myself in some way if something went wrong in my life, and usually it was through restriction and purging. I still have scars on my left arm, which is shameful. Admitting this publically is actually very scary. Only a few people know where those scars actually came from. When people would ask, I’d say I had accidentally burned myself with my straightening iron. The irony in this is that just a few months ago, I actually DID accidentally grab my skin while straightening my hair and burned the very arm I used to scratch. I guess my flat iron got sick of taking the blame and decided to play a little double jeopardy 😉
For some reason, after bouncing back and forth between the day program and the residential program [at the second Boston treatment center, if your weight drops in the day program they try to support you and help you. If it keeps dropping, they try to get you admitted back to residential treatment to get you back on track. This is why I respect program #2 over program #1. Program #1 has since closed] I was finally discharged from my 6th and final stay in residential treatment at the end of January 2012 after beginning my journey in to recovery in June of 2010. I refused to go to Partial [day program]. I didn’t think it was helpful at all. I wanted to do it on my own. And I did.
Growing Up Alex: Being In Recovery will be posted on Monday 4/7/2014. Make sure to follow the blog to receive an e-mail for when it’s posted or follow it on Bloglovin‘!