Anorexia Insites...

Hey Friends, There was some brouhaha this past week on the main board about a young lady that had gone from heavy to anorexia. Ya’ll all saw the post, after some flaming, she shut down her profile, so I was not able to see the pictures…but I have seen this type of action before and I wanted to give some insights as to my experience with these people… These are some of the most difficult patients to deal with, it is a delicate balancing act to treat their medical condition, when their mental issues get in the way.. We really have no point of reference to start understanding what their mental issues are doing to them, to be indelicate….they are so far out their that we can’t relate…on hardly any level, we cannot even talk to them without being frustrated…as it seems happened this week. It is not just that they are in a state of denial; they have lost their grip on reality. They live in a world that is not based on any reason or logic. Which is fine, I like my fantasy world, but the difference is, I do not let it kill me, or do permanent damage to me…. We have all had bits of denial in regard to our weight, but this goes way beyond wearing a tube top at 400#. Please know that I’m not flaming anyone, just wanting to share my experiences, these people, set themselves up to make it difficult to communicate, it really is quite paranoid. They will say they want to gain weight and do every obstructive thing to make it not happen. Example, “the Doctor has said you have to drink this protein shake.”…Ok simple enough….First it is they will drink it out of a can, then it need to be poured in a cup, , then do you have another flavor, I want it over Ice, I don’t like the Styrofoam cup, I need a straw, this straw is bent, I don’t like this cup, the ice has watered it down, and then…opps I knocked it over in the floor,  and not one sip was taken and no nutrition was consumed. So the doc puts in a central line, or a tube in their belly, to give them nutrition, and the machine will get turned off, the bag will have a hole in it, the machine will be flushed down the toilet, the central lines will be pulled out, their g-tubes will be pulled out… All of this completely explainable by the anorexic, and very frustrating to the healthcare worker… Ok so lets lock them up and tie them down where we can save them…. NO can do….this is very complicated, a person being seen in a psych ward, has got to be physically stable…they cannot need to have IV’s or tubes, because there are other unstable people around that may want to pull at their tubes.. So the patient has to be seen on a medical floor, that has very different rules and guidelines…there is a patient bill of right, that states you cannot force food or nutrition on the patient….and there is a legal liability for crossing that line…. Nurses are their to help people that want help, not to persuade people that so not want help…so there is the dilemma…. These people are a sad lot, and very frustrating, and I do not have one clue as to how to help them….. As you can see they can be very vocal, and defensive, and they reject all forms of help.  You have to remember, the  break with reality. As simple as we see it is to fix the problem , and how dangerous it is….they do not se it…. And so the cycle continues…we want to help, and they don’t think they need it… Ok I’ve rambled enough, but just wanted to share some of my experiences… These people are to be pitied. It is to tragic.. Russ

Russ, You obviously speak from experience.  It is tragic and hopefully this young lady can get it worked out.   Scott

Thanks for the info Russ.....I think part of the issue is that we have to learn to accept our bodies post op. I've said before in posts, unless your a raving lunatic, who tells the psych doctor that you think WLS will give you wings and make you fly like peter pan, they'll basically sign off on the surgery.  Most psych's don't require long term counciling (neither do surgeons) for preop and post op WLS patients....hence you get people who say "all the right things" to get signed off for their surgery, and then go over the deep end after they start losing weight.    It's really a slippery slope....when have you lost enough weight?  Whats the magic number?  Can you be happy if you never reach that number?  What about all the lose skin on your body, what if it doesn't get removed?  WIll you keep trying to lose weight until it goes away (which it won't without plastics)..etc etc.   I have to believe there is some "addiction" transfer going on in this whole situation.  First people got attention because they were fat, then they got attention because they lost weight, and when that starts to fade away....they start doing destructive things to get more attention.  On some of that thread, this woman was "flamed" because she had posted in the past about "how she felt sick", "how she goes to 4 doctors and they are all worried about her", and "how she went down to 88 lbs and everyone was scared for her"...then in another post, she's posting "look at me in a bikini, I look so great and feel so great"  I had a sister who became anorexic, she became very "ritualized" in her eating habits.  She had to have a super amount of control over everything she ate, and she started to eat only one type of food day and night.  Eventually after several collapses, she got therapy, and overcame the issue...and gained back all the weight she lost. 

Scott

Russ, Thanks for the "insider info" on The condition. The post, and the discussions around it bring up an interesting dilemma… A lot of people, *****sist help, do in fact require intervention to survive. So who's responsible? Her Family? Physicians? Co Workers? Does that stretch to "those who know about the problem and those she’s turning to for advice? Like- Strangers on a message board? It’s sad. For those who posted typical good advice- "Do what you must to get healthy!" I applaud their attempts. What I found aggravating were the folks who see "Support" to be the same thing as "Coddling." Her post indicated that the last time she posted on the Boards (and each time she creates a major stir) Some had told her she looked and seemed –"Great-Keep it Up!" Some of the responses to her two threads this time had similar- "Great Job" –pat on the back – (((HUGZ))) tone to them. From her postings in the past, her BMI is a 16. A BMI below 17.5 is considered anorexic. Her profile was a mix of two very different tales- 1.) My Doctors want to put me in the hospital and "put fat in my veins," I’m vomiting more than twice a day, I don’t have the energy to get out of bed, I blackout often….etc… 2.) I’m skinny, and I’ll never go back! I look young again, People are jealous of how thin and great I am…etc… There is that "textbook" psyche issue with some anorexics who fear or resist growing up. The whole "If I’m ‘Small’ equates "Child." Often the majority have been raised by a super controlling mother or parent. Many have been sexually abused. I think her statement about being a "sexy little woman" is very telling. That whole –"yearning to be sexy but any evidence of maturity on her body is starved back into a childlike state." The responses of- "They’re just jealous…" "I think You’re Looking Great!" "Don’t listen to those who are negative…" "ignore them…Mean People Suk!" They "mean well" I suppose, but by confusing "Support" with "Coddling" no thought or concern is required or offered…just a ‘boiler-plate’- ((((hugz))) " Kissy-Poo-To-You! " For her to receive posts/replies supporting her predicament, only serves to strengthen her problem. The same is often true when folks post – "I’ve been bingeing on potato chips and cookies, and the weight is flying back on!! What to Do?" There are a herd of "Glitter-kissy-tickerfactory-smoochies-pixies" to rush in and offer such sound advice as- "That’s Okydoeke Hon! You can’t live your life depriving yourself! We all do it! (((hugz))) Have a blessed Journey sweethart!"   No offer of- "have you tried ‘water-loading?’ or upping your overall veggie intake?" Nothing… No help, just enabling, trite, platitudes about – "we’re here for you" ---when clearly, they really aren’t. I swear some days I could post on the main Board- "Help, I’m eating sticks of butter dipped in Molasses! And Have Been All Week!" And there would be the response of- "Don’t get discouraged, look how far you’ve come, and Butter is a Dairy! Smoochies!" I’m all for throwing an arm around some one’s shoulders who’s having a rough time, but I think the occasional "twack" to the back of the head is equally appropriate. Honest advice doesn’t mean judgmental condemnation. As I have been known to tell a student who is screwing up- "You’re not a F’-Up, but right now you are F’-ing-Up!" That poor woman that posted is inching closer to death every time she posts. At least when an Anorexic falls over eventually, someone can at least stick a TPN-line in her and pump in some nutrition. When someone out on the Boards is having the same ‘denial-problem’ at the other end of the scale, and finally drops from the excess weight, what hose can they stick in someone to pull some excess nutrition out? Either problem is only made worse by those who rush in to offer "incomplete" support in the form of absolution from all consequences. In an attempt always be Nice, some will remain "un-helpful" to the point of enabling life threatening behavior. I’ll stop babbling now…. Just makes me crazed sometimes… I do applaud those who continued trying to offer helpful advice and wake-ups to that woman, or anyone for that matter, even when met with resistance. For those that jumped in to prop-up the bad behavior in the name of "Nicey-Support?" Booo! Best Wishes- Dx

Excellent post, Russ, and great responses so far all around, especially Dx!  You have a such a way with words (and sparkly emoticon gushies). For me, (as someone who has always had crazy people in my life), the take-away message is this:  It is what it is.  No matter what we do to change people's behavior, sometimes we are completely powerless and we just have to accept it.  We don't have to like it, but we have to accept it for what it is.  It's never easy to see someone slowly comitting suicide by (INSERT CHOSEN METHOD HERE:  ANOREXIA, METH, HEROIN, COKE, ALCOHOL, OVEREATING) , but when someone is hell-bent on doing it, there is really very little to be done. Sending out flowery messages of pseudosupport makes the sender feel better but at the end of the day...what was really accomplished?  Nada. Interventions go only so far.  If the person does not want to get better, then all the positive feedback you give the person sometimes damages the situtation even worse because it fuels the underlying pathology.  I have learned that sometimes, when you hear the tires screeching around the corner and they're heading in your direction, the only thing you can do is get out of the way.

Right on Dx, you have hit the nail on the head - as usual. This entire episode is a prime example of why I generally stay away from the estrogen dominated main board.  Keep up the good work, Dx  smoochie, smooch and all that lame crap