Body, Mind, Spirit

Some years ago (actually in the 1970's)  the "Six Million Dollar Man" was a popular television show.  The series gave rise to "The Bionic Woman."  For those readers who weren't born yet, these series featured people who had what have now become more commonplace - artificial parts to replace or shore up our failing human biological components.  Nowadays, one can get implants or transplants for just about every part of the human body; an exaggeration, I know, but so often now we read of a new miracle of surgery and science.

My mother, had she lived a few more years, might soon have been able to see clearly again.  She lost her eyesight to the dry kind of macular degeneration and with the loss of her sight went her independence.  She soldiered on, as she put it, for a few years - until she turned 89 -  before she died after not surviving hip transplant surgery.  An artificial eye is on the horizon.  What a miracle that will be.

Any one of us now, given availability and more importantly insurance or a fortune or means to repay a loan, can get a tooth implant, a heart transplant, a liver transplant, and a new knee or hip, for example.  

One's teeth are covered by dental insurance, one's body is covered by medical insurance, in fact one's brain is covered by medical insurance, but the coverage of one's mind is at the whim of insurance companies or the government laws/legislatures.

Think about it.   Aren't your teeth part of your body?   I overheard someone speaking to my dentist this morning and he remarked he needed to return to his periodontist to be treated again at $20/minute.  One single tooth implant can cost upwards of $10,000 out of pocket  while a much larger and more complicated hip implant can cost you a relatively small copay if you have medical insurance.  If you suffer a stroke and are without insurance, you still can go to the hospital and get treatment that inevitably will be covered by some kind of insurance or absorbed by the hospital's financial machine (to its detriment).

But if you have a mental illness such as bipolar disorder or an eating disorder, good luck getting enough coverage or any treatment even if you have insurance with a mental health component so you don't have to go home prematurely (meaning before enough treatment is provided to reverse the effects of the disease) to die as someone I am somewhat electronically acquainted with put it recently.  

Aren't all of these organs from which these illnesses develop part of the human body?  Does it seem ridiculous to you as it does to me that there's no integrated insurance coverage to address all the ills of our bodies?  

Having studied anatomy and physiology in college, I became in awe of the interconnections of all parts of my body.  We spring from this tiny egg that is fertilized by a little sperm and eventually are born into this world with everything working correctly, if all goes well.  Beyond birth, our bodies are subjected to the vagaries of existence on this earth ranging from diet to shelter to opportunities.  

Yet when it comes to medicine, our bodies are splintered into parts that are addressed separately by members of the medical profession without regard to the fact that an abscess of a tooth can lead to death of the body, that dehydration and electrolyte imbalance can lead to death of the body, that a heart attack can lead to death of the body, that an infection from bacteria introduced to an opening in the skin when getting a transplant or implant or even a cut can lead to death of the body, that a imbalance of substances in the brain can lead to depression that can lead to suicide/the death of the body.

Read the above again.  Every single one of the things I've listed can and does happen to those with eating disorders.  Every single thing.  And yet our government of the people, by the people and for the people does not provide adequately for those who have a mental illness, even those who have insurance!!!!

And spirit?  What about spirit?  Wikipedia provides a rather broad definition of this term.  About three years ago I participated in a Family Week during which our group leader remarked that we are all spirits, if you think about it.  Our bodies are made up of molecules that are made up of particles that are in constant motion.  The body electric.  What happens over time to someone whose spirit is not nurtured, whose very being is maltreated or ignored.  Death.

Isn't it time to take a harder, more accepting look at  holistic medicine?

I think so.  I am angry that I need to go after these different facets to address and advocate for the well being of my loved one.  That one "side" won't work with the other "side" even though the basic team that meets includes all sides.  There's something wrong with our system.

Terms and Definitions - "Clinical Switch"

As do most professions, Behavioral Health (meaning mental health, mental illness, related substances abuse) has plenty of acronyms and code word expressions.  Over these last eight years I've needed to learn many and understand the nuances, too.

For example, now that my loved one has been released from the latest in a series of eating disorder residential treatment facilities due to non-compliant behavior (definition variable and behavior common to those with eating disorders) and medical issues that need to be addressed, the newest one I've come across is "Clinical Switch."   The meaning of this expression became instantly clear because it was apparent that my loved one's primary diagnosis of eating disorder is not driving everything; rather, it may be a secondary diagnosis made in the Spring of 2007 after years and years of behavior that seemed to point to it that is now believed to be the basis.  At least, that's where things stand now.

Yet, anxiety was present from a very early age, too.  Here's a recent post that includes a thoughtful discussion by Dr. Bermudez, a pediatrician, and doctor connected with the ERC.

So was "picky eating."  (I need to find more information on this because there was a useful article about this that appeared sometime in the last three months or so.)

I've been advocating this follow up stance for several years now on a website for eating disorders; namely, if your son or daughter has become re-nourished and has reached the target weight and has sat in his/her body for quite awhile, in acceptance of that body, yet maladaptive (another term) behaviors continue, it's time to seek another examination by a competent psychiatrist.  In fact, two opinions wouldn't hurt. 

Then, it's important to push for a re-examination of the entire situation.

As Marya Hornbacher notes in her book, Madness (Houghton Mifflin, 2008) in the chapter "Bipolar Facts" (pp. 281 - ), the average age of the development of Bipolar Disorder is 23 yet the average age of correct diagnosis is 40.  I imagine this may be the case for plenty of brain disorders that have symptoms that overlap.

Bipolar disorder (you may have heard the expression manic-depressive or you may have Kay Redfield Jamison's valuable memoir, An Unquiet Mind (Vintage, 1996)) is variable.  Some people have rapid cycles; others do not.  Without going into a lot of detail, this was one of my loved one's potential diagnoses when things turned really south about 9 years ago.

Besides anxiety disorders, Borderline Personality Disorder (BPD) should be suspected to be a possible driver.   From 25-28% of those with BPD also have an eating disorder.   An excellent very thick book is Get Me Out of Here:  My Recovery from Borderline Personality Disorder by Rachel Reiland.   The book gives the reader a lot of hope because the young woman did make progress.  So have others.  An excellent tool for treatment is Dialectical Behavioral Therapy, a method developed by Marsha Linehan.  A very good website to explore is dbt self help.   This site provides a definition, provides skills lessons, videos, and statements by those who are working towards recovery (among other things).  It was written for those who have the disorder rather than professionals yet it is comprehensive and understandable.

I've already in another post mentioned an excellent book by Randi Kreger titled The Essential Family Guide to Borderline Personality Disorder that I bought a couple of years ago when I began to really pay attention to the idea of a secondary diagnosis -- the term co-morbidity applies here.

The National Institutes of Mental Health provide a link, as well, for BPD.

So, enough of that.  I don't like labels; most people don't, either.  Pigeonholing someone in a diagnosis is a dangerous thing which is why the team has proceeded very carefully.  But it's time to take a more serious look.

What a digression!  On to some additional relevant definitions:

Clinical Switch - this should be obvious now as the therapy direction will be towards BPD and less so towards the eating disorder, which indeed is a mental illness.

Dual-Diagnosis - for the longest time I didn't have a clue what this meant until I attended a NAMI Family to Family series of classes and learned what it meant.  Many people with mental illness of all kinds will turn to other substances to calm themselves - something called "self-medication."  I thought the term meant co-morbidity.

Decompensation - I've heard this expression a lot lately.  Our local newspaper, The Arizona Daily Star, has begun a four-part series on Mental Illness .  Two full pages of the newspaper provide definitions, resources, and other information of vital importance for families who are trying to help a loved one with a mental illness.  I hope this series of articles will remain in the public domain as the information is so important. The definition provided by the Arizona Daily Star (p. A21) is "what happens when the condition of a person with mental illness who has been stable and functional, often on medication or other therapies, deteriorates and the person shows worsening symptoms of his illness.  A decompensating person is likely to end up in a mental illness crisis if he's unable to get treatment."

These seem the most relevant now. 

Nothing like a nap!

This week has been wild, full of ups and downs connected with not only next steps for my loved one, but also arrangements for an extended family member who suffered a stroke almost two months ago and who lives in another state.  

The outcome in each case is to be determined as often happens, but things look promising.

At times like these, when life can get pretty unmanageable, I think of a very useful acronym:  HALT

Hungry, Angry, Lonely, Tired.  Here in the desert southwest T could also stand for "thirsty".  In fact, I just took a large glass of ice water out to my husband whose hobby is working on his car and he's been at it for a couple of hours on a rather hot afternoon here.

I, though, was tired.  After going to a meeting and then running several errands on my way home (including filling up my almost empty '03 Murano's gas tank and gasping at the total - $72. and change), I came home, had lunch, and climbed into bed.  A two hour nap was just the ticket so I could help my husband out in the garage by sorting things for Goodwill.  It has been a productive afternoon.

Back to the fill up for a moment.  As I stood there by my car looking at the receipt (I got 19 gallons, the Murano needs premium, and I had been running on air for about a mile), a woman who had just filled up her gas tank nearby remarked, "I'm going to frame mine.  This is the most I've ever spent on gas."

I guess there's a metaphor there.  My car was empty and needed gasoline; I was empty and needed a nap.

Thoughts on being a Mom

Today's New York Times carries a piece in the Modern Love column of the Sunday Styles section (Sunday, April 10, 2011, p. 6) titled, "Sharing the Shame After My Arrest."  The piece, by Brooke Rinehart, tells the story of a young woman very in love with her husband, a young enterprising man, who betrays her.  She returns home to her parents who love her and support her through the agony of the next ninety days.

My daughter's birthday was last month and mother's day is approaching.  Yesterday in a meeting I shared how difficult it has been for me to somehow construct a boundary between me and the woman who, as a baby, nursed at my breast and delighted my heart.  As I've also shared not only here but also in an IAEDP meeting with a bunch of therapists who treat those with eating disorders, I also sought therapy and attended classes and  gradually came to understand that I didn't cause my daughter's eating disorder.  The situation we all lived in may have contributed to its emergence, but genetically there it was.  As happened to many moms, I was blamed in an "earlier time" and carried guilt around like a wet blanket until I began to learn how to accept the past, understand what was and is going on, study the science of it, and move forward.

So, reading this piece in the New York Times today actually strengthened me, the mom who was declared in 2004 to be without boundaries and too enmeshed in the situation affecting my daughter.  

The writer shared that she could not lie in her bed in her old bedroom because it held too many memories.  I could relate to that.  After my divorce, the best thing I ever did was to sell my house and move to a different one.  And, it was a wonderful house but in our experience it held too many sad memories.

So Brooke slept on the couch for ninety days......  And along side her, in the love seat, slept her mother.  Brooke didn't ask her too; she just did.  Brooke writes, "At her lowest point, my mother spent a full day on the laundry room floor, slumped against the washing machine, unable to move.  The severity of my situation had consumed her.  Her heart had broken so severely that her body and mind broke, too."

Yes.

She writes that her mother sought therapy for a number of reasons, not the least of which was to "stop making this about her."  I so understand that.  I was consumed by the agony of watching what was happening with my daughter.  As I said to the group of therapists, "How could I not be enmeshed?"  Yet, this was and is not about me.  Yet, from another perspective, it is.  And, I had to learn how to detach with love in order to be a better advocate for her.

Time has past since yet there's still a part of my heart that finds it so hard to accept what has happened to this joyous, creative, and intelligent little girl.  She's in another rough patch and I know she can make it through to the other side of this -- after all, one has to go through something rather than skirt it.  She has the support; she needs to do this.

So can I.  As my little plaque says, "Life is all about how you handle Plan B."

Thoughts about running and being....healthy

Reading a post by Carrie on her Ed Bites blog about mind vs body and then seeing a graphic portrait of a skeleton running on a treadmill published by CBS the other day (I am not going to link to it as I was shocked by it), reminded me of all the times one of my adult children admonished me for continuing to buy my loved one a pair of running shoes as one present for Christmas and another for birthday. I just didn't "get it."

My epiphany on this issue came one or two months ago when I realized that I was an enabler by providing the shoes.  After all, my loved one loves to run and go on long walk-abouts, as we call them.  I figured (incorrectly; see most recent post) that my loved one was running for the exact reasons that I love to run and now walk.  Actually, I am sure that part of her does for the very reasons I do -- incorporating what can be a healthy habit into one's day to get some fresh air and sunshine as well as to get the heart going, the lungs expanding, the hormonal systems moving, etc.

But running came into our lives differently. 

As I've written here on my blog, my parents always encouraged sports and outdoor activities.  We lived overseas in the tropics/subtropics for most of my growing up so outdoor sports happened year round.  Sports was a part of my life and part of my during school hours life, too.  I raised my children the same way.  Living in Tucson with its wonderful year round weather helps that. 

But I did not "discover" long distance running until I saw a friend of mine running around the neighborhood and asked her a few questions about it.  I learned that it was an activity I could pursue early in the morning before my children woke up and needed to get ready for school.  I came to love it very quickly for reasons I've also written about.  But, for me, most importantly I wanted to keep doing it and I realized that to do so, I needed to be smart about it.  Having a medical background (nursing student) and a keen interest in physiology helped me realize I needed to eat well.  I also had just begun my own recovery from bulimia and soon learned that putting a few more pounds on did wonders for me in terms of strength and in terms of fighting my frequent bouts with bronchitis.  In fact, I learned as time went on that as soon as I went under what was still a very healthy weight for me (this happened when I was stressed), I'd get sick with bronchitis or a cold.  It was my body's warning system going into action and I heeded it.  My doctor was very happy about the change, too, and encouraged me to aim for a weight that he felt was even healthier.  I did that. And, I felt even better.

My loved one, however, was introduced to running while very young - nine years old.  Running became a part of her life which I thought was a good thing.  However, as she reached her mid-teens, exercise became one of the ways she dealt with anxiety and later assisted her along into anorexia.  She continues to use it as a tool to keep herself there or get herself back there.  She also incorporated what we called the walk-abouts.  These were very long walks around town to avoid binging and purging and other behaviors.

Each time she has been released from a residential facility or hospital, she has returned to running/walking even when her electrolytes were horribly skewed and/or her weight was low enough that she reported people would yell out their car window at her to "gain some weight."  She would come home very upset by these remarks yet could not connect the dots to see why others were reacting to her physical looks.  She just didn't see it. 

Now I have gotten beyond my denial to understand that she is incapable, at this point, of using running for just a healthy purpose.  She still craves it.  One of her hurdles will be to understand the difference.  My role  is to set a boundary by not purchasing her running shoes and by standing firm with her team and asking her to not run and not walk long distances until she figures all of this out.

As a former runner (I walk now as I have arthritis in my neck), I do remember at times getting injured with tendonitis like symptoms and experiencing what is called "withdrawal" because, let's face it, running and or walking/hiking for those who love it, feels good.  I get out, away from cares for awhile, I can think things through without being disturbed by the phone, or I can just simply enjoy the sounds of nature. 

For those who find that exercise can undermine them, and are cognizant of it (like Carrie), stopping for awhile is necessary.

All in the Family......... and elsewhere

I knew I should not have picked up the Wall Street Journal before my walk this morning.  I love this section and usually learn so much in a few short pages.  The temperature's quite cool  today after a terribly hot week last week and I've opened all the doors as well as the one to the screened porch.  Our cat is in heaven and hasn't come back into the house for a couple of hours now.

As usual, the Personal Journal's Health and Wellness section that appears on Tuesdays is crammed with interesting information about Sleeping Types (are you a short sleeper?), other options besides bypass surgery, food addictions (I hope folks pay attention to this study because as I've said previously here, I do think there's a genetic link to all of this), and especially the article titled, "Do You Get an 'A' in Personality?" 

In an earlier post I talked about Family Week at a residential eating disorder facility, communication,  and the value of the exercise that uses Gary Chapman's book, The Five Love Languages.  Along comes an article that delves even deeper into the entire subject of co-existence and family relationships.  

One of the neat things about people is we can be related and yet be so different!  One family member might crave peace and quiet while another just loves to crank up the latest rap recording.  (The solution here might be headphones.)  Another might want everything to be "just so" while a supervisor might find "organized chaos" to be the answer in his/her office.  I'll never forget one summer when, having not too much to do while my three professors were on vacation, I "straightened up" one of their offices, placing books in alphabetical order and so on.  Well, although I did not get fired, I did get a dressing down.  Before I did this, he knew exactly where in each stack or where on the desk or table a specific article or book was related to a paper he was working on.  When I was done, his entire orderly (so to speak) world was upside down.

In this latest article, Elizabeth Bernstein grabbed this reader by noting in the first paragraph, "In the never-ending quest to help people co-exist peacefully with their spouses, children, siblings and in-laws, therapists are turning to tools used to assess the psychological stability of pilots, police officers and nuclear-power plant operators: personality tests."

Bernstein focuses on the family, especially one with a teenage daughter who moved back into the household and who has an entirely different lifestyle from that of her parents, who are goal-oriented - mom's an accounting consultant and dad's an attorney.  Their daughter, Maggie, "....is an introvert, a feeler who craves harmony and needs time and freedom to discover what she wants to do."

Bernstein then notes that mom, after she and her husband and Maggie took the test and heard the results, said, "It helped us see that she is a different person and will have a different path."

Key words.  Important words.  Our children are different people on different paths.   

I think this article is especially important for families whose son or daughter (or both or all) struggle with perfectionism, anxiety, and an eating disorder.  As many specialists will note, particularly those who are up-to-date in the eating disorder field, for progress to be made in a family whose member is struggling with an eating disorder, there needs to be a calm and nourishing (pun intended) environment.  If the family members do not understand each other on a much deeper level, it's more difficult to create that environment.

For years this tool has been used in the workplace.  Perhaps the MBTI could be considered another window into the activities of a family, now that family members are increasingly -- thank goodness -- being accepted as members of the team.

Time for my walk!