"She Looks Ten Years Older" -- Consequences, and the Bind

Although what follows is about consequences of illness/addiction, I hope it will be of interest to writers as well as people interested in healing and honesty.
Every writer learns to manage a multiplicity of points of view: to think within her own head, and within the head of someone observing her, and within the head of someone she's observing. Any person could do with this same ability. Any person who's aging, or sick, or struggling with an addiction, could do with learning this, too. People in this category are precisely the people who can maintain an unrealistic perception of ourselves (yes, I include myself) and our abilities. For example, Phil's dad fell off ladders and into creeks in his later years, because his perception of himself as all-capable physically never got updated as he became eighty-something with blown-out knees and a triple bypass; which is why my grandma, formerly super-active, is beyond bitter and frustrated at her confinement to a wheelchair.

once you're in the vortex...

So, to forestall any backsliding from me based on claims that there's nothing wrong, that everyone's making much ado about nothing, that bmi guides are arbitrary and silly and what are you talking about 'dangerous,' I'm going to lay it out there. There are consequences to the 'mandatory intervention range' prize, and I'm going to share them here--the ones I can remember (see below)--as part of holding myself accountable. 
These are things I am not willing to admit to anyone out loud. I'm admitting them not out of narcissism but a desire for clarity and completeness, and to help.
There's also a major bind, which I'll also mention.

Consequences
- Physical strength is a prime area of mistaken self-perception. I can do all my regular bodyweight exercises fairly well, so I'm just as strong as ever, right? But stepping out of my own borders, I'm having trouble opening heavy doors, or lifting 15lbs above my head, carrying big grocery bags, etc.
- Soreness, fatigue. Yes, my muscles get and stay more sore. Yes, I get really tired. And I'm not abusing stimulants as I was in the spring, so no getting around it.

- Memory loss--I'm famous for my memory, and have always been glad to rely upon it. Lately, though, I've felt like an Alzheimer's patient, between finding myself somewhere and wondering what I'm doing there, and losing a word, and not remembering what comes next in a process. All short-term memory stuff. But yesterday I cried when I couldn't remember a friend's phone number and had to look it up. OK, it's just one digit I couldn't remember, but really, phone numbers are a package deal...
- Logical awareness and balance--as in my body, so in my head. A level of meta-awareness remains, where I can hear that what I'm saying makes no sense; but my logic, usually impeccable, isn't straight at times. I stare down the depths of a conversation and see a whirlpool in a drinking straw, and am helpless to squeeze things back up. That's a good part of why I'm writing this post, as I can logic myself out of doing all kinds of things I should be doing.
- Spatial awareness and balance--my goodness, I have become the most laughable klutz. If I pick something up, it's almost a given that I'll drop it. If it's anywhere near me, I'll run into it or tip it, or bruise myself on it. Sometimes I lose my ability to touch-type, or even type the semblance of the right order of letters.
I often get lightheaded when I stand up, or bend over. When doing my signature kitchen dance (no, not "chicken dance," even though I'm mixing up my words too these days ;) ) -- normally, I'll whirl from one area to another, picking up, setting down...I've actually put my butt down more than once.

- I'm in ketosis, holy grail of Low-Carb dieters; not on purpose. Some consequences of ketosis:
  - horrible breath. Can you imagine how mortifying that is?
  - worsened hallucinations. Yes, I have them normally anyway, but more frequent, more scary; consistently in several senses (visual, auditory, tactile at least). There's actually a bit of research recommending ketogenic diets for folks with bipolar 2 but the psychotic piece is a specifically cited reason why it's not for bipolar 1's.
  - stress on the kidneys (who have already been extremely and repeatedly stressed)
  - some heart-stress-type stuff--see, I never normally go away from my doctor without chapter and verse clarity!

- Hair loss. This wasn't happening earlier this year; grounds for my claims that nothing was wrong. It's falling out like crazy now, and I have pretty long hair.

It gets into everything!
- Hypothyroid--I have this already, as a long-term consequence of this illness/addiction. I hadn't noticed until I saw a picture of myself, though, that my eyebrows are disappearing: a pretty sure sign that I'm not taking enough thyroid med for how hypo my thyroid is.
- Amenorrhea--a given, pretty much my whole life even if you don't count childhood. Pretty convenient, except that it causes estrogen dominance, and the lack of progesterone affects smooth muscle contractions (think: peristalsis) and adrenals (think: containment and resilience) and many other hormonal functions.
- Gut stuff--food allergies and sensitivities worsen; digestion and absorption less effective with impaired peristalsis; irregularity.
- Absorption issues--both of food and of necessary medications, since both brain and gut are missing what they need.
- Adrenals--shot. Jump a foot in the air at anything sudden or loud; find it hard to make on the spot decisions.
- Aging--what a painful irony after all the fruit-and-vegetable eating, all the attention to good herbs and sunshine; hey, and all the calorie restriction. That's supposed to conduce to longevity, isn't it? I've always looked young for my age. Now, I'm being told I look ten years older. I really don't know what to do with that. I've never wanted to be vain about my appearance, but my youthfulness is something I've taken for granted.
- Honorable mentions: intermittent chest pain, impaired judgment in decision making (e.g. drinking a gallon of water preparatory to weigh-in, to make things look better vis-a-vis the ultimatum. Things look very bad. People were fooled as to the quantity but not the act. Three days later, I'm finally not feeling sick from this. Or, going on a long hike without having had lunch. Or, driving while hallucinating to be somewhere I needed not to be hallucinating). Having a hard time seeing the funny side of things, which doesn't help with the extreme relationship difficulty. And more...

The Bind
"Some" of these issues will be helped by gaining "some" weight--less than they say, in my experience. Improving nutritional status is more the key However, some of the physiological issues won't be changed, although they will respond better to medication.
Even more of a bind: weight restoration doesn't deal with the underlying issues. At all. I was barely close to 'fully restored' when I left treatment this time, and I was just uncomfortable. Last time I was in treatment, I left 'fully restored,' which just led to losing a shocking amount of weight in a very short amount of time, together with other 'behaviors,' and running away from any kind of treatment for many years. When I've been at relatively 'normal' weights, my pain and discomfort with that clouded anything else that was going on to the point that it was hard to access underlying issues. I've known friends undergo exactly the same thing, so I'm not just speaking for myself here.
Based on my experience, there has to be a compromise--especially with those of us who are older. A weight range that's lower than 'standard' but still healthy. That will allow us some physiological ease, while removing enough of the 'mind panic' for therapy to actually reach. I think this would be a far more effective strategy than putting people on Zyprexa or Seroquil so that they gain weight behind their own backs and then feel betrayed in the ultimate manner.

Full disclosure and my own bind: when I left treatment, I was just at the top of the 'compromise range' I had proposed to them. Even more reason for me to walk my talk now.

On Integrity (Part 2) -- Word-playing, Coconut Cream Again

In my previous post, I requested your indulgence in allowing me to explain my circle picture in the context of integrity.
You know I love words and etymologies, right? Promise not to be bored if I play with them for a bit?

Entire=Intact=Integrity. 

Yes. "Entire" comes into English via French, but all three words come from the same Latin roots. "Intact" has the closest meaning to the literal Latin--Untouched.

So, "Entire" comes from a root meaning "Untouched," and so does "Integrity."

How does that work? Interesting to consider that entirety--a sum total--and integrity--a moral characteristic--could be the same kind of thing.

Try this on for size:

Something can be Entire because it is untouched--nothing has been taken away from it. Also, nothing has been added to it. Both kinds of 'touching' are relevant--subtraction and addition--if you put too many pencils in the pot, you might break the pot (or the pencil), or warp its shape. Entire means not too much, as well as not too little.

Someone can be in Integrity because their intent/affect/character is untouched--unmoved by circumstances, concepts, intentions. Perhaps it's a case of entire congruence between a person's attitude and that of external circumstances. Perhaps, Integrity is a kind of wholeness. That's a good way for me to understand it, even without the etymological connection. Integrity is a kind of wholeness in the same way as Entirety: it's being untouched--no pieces missing, no extraneous pieces added.

Then I find myself moving to circles within circles, and some subversive thought patterns. Who says what elements make me whole? And of what whole am I, in turn, a part?

Is drinking all that coconut cream part of being in integrity, if I do it? Is it touching me by making me entire, or is it squishing me outward like the pencil pot?

Is drinking pints of extra liquid before weighing in part of being in integrity? Is it making me entire by allowing me to present the required weight? Or is it out of integrity because it's squishing me outward in a fictitious manner?

Are my intentions sufficient to define integrity? For example, does my intention to show the required weight on the scale by the end of the month so that I can stay on a vital medication mean that making up a lot of that weight with water is in integrity, given that I didn't state the intent to actually gain weight? 

At which level of existence is integrity defined? Microcosm--Am I out of integrity if I pull the skin off my fingers, 'touching' myself by removing parts of myself? Or are those parts unnecessary? What about brain cells that get wiped out by lack of glucose and fatty acids?

Macrocosm--does my presence, absence, alteration, or death affect the integrity of my family, my social circles, my MFA program, my employers? Does it make those groups incomplete? Or does it remove a small appendage, easily cauterized; symmetry easily restored with just a little shuffling? 

And--am I just a member of family, social groups, etc? Or am I also a member of the universe of the hallucinations? I'm in and out of their world all the time, but I don't see a lot of my friends and family every day either. Would they miss me? Do they need me to be there for integrity? Do I have to pick which universe I exist in, for integrity's sake? (Hallucinations get worse if you're in ketosis...Yes but they were pretty bad in treatment at times, being stuffed...)

I went from playing with words to speculation about the cosmic implications of those words and their meanings but that's all pretty abstract for a life and I'm starting to doubt that I make sense here. 

My naturopath had me sign a contract today that I would get all that coconut cream down, so as I start to find excuses not to do so and fudge around, as of course I've done already today, I will have a piece of paper as a prop to consider my integrity and impeccability of word. I already called him once to clarify a loophole I'd found. Phil said "Of course he didn't mean that" but getting the clarification rather than just using the loophole may have been an act of integrity.

Here, I stop. I had a clear idea of what I wanted to say, but clarity has fled today.
I even managed to close this window, thankfully without losing the entire post. Please bear with me. I continue working on being impeccable with my word.
Perhaps the magic word is that coconut cream and food will help me be better in integrity, in whichever universe I exist, however I am present.

Frank Talk about Post-Treatment: (1) Food: A Return to the Exquisite Privateness

What happens when you get out of treatment? First of all, you don't want any special attention as a result of where you've just been; especially, you don't want to appear to be making any special efforts around food. 
Do you?
I didn't. On reflection, actually, some of my fellow travelers took pride in the prospect of showing their loved ones that they were doing things differently, better. So perhaps I just speak for myself. What I do know is that nobody wants the "Oh, you've gained weight! You look great!" comment. I've had that one a few times on previous go-rounds and it is an enforced lesson in grace.

In view of this, I was lucky: the day after I left treatment I went to our MFA residency, at which the majority didn't know me well enough to know where I'd been for the previous ten weeks and probably hadn't noticed my food oddities the year before or remembered them if they had. I left the residency to a freewheeling crazed run of travel and family stuff, during which there were far greater priorities to attend to. My friends and family, most of whom didn't see me until a month or so after I got free anyway, are dazzlingly tactful.

Additionally, I don't talk about it. Not-talking, like talking, is powerful energy.
I'm choosing to talk about it now because I suspect it may be helpful for someone else, and possibly even useful information for people who know me. For this post, I'll talk mostly about the food aspect, but in a later post I'll talk about other aspects of life affected; not least among them, not-talking in a different context.

Being on the outside is not the same as being in treatment. The only reason I state something so obvious is because when you get out of treatment, the otherness is such a shock. Even stepping down from five weeks inpatient on a campus in the middle of nowhere to a day program in a city, with streets and cars and stuff, was overwhelming to the point that I was barely coherent at first. From there to 'total freedom' was another rush of adrenaline. In theory at least, they don't let you out the door of a treatment center without a multifaceted "plan," including an individualized meal-plan (considered the foundation of all growth both metaphorical and literal (!)), a therapist, a doctor, a dietitian and, if necessary, a psychiatrist (it usually is necessary), plus scheduled appointments with each of these. There are always people who fall through the cracks and get home without any of the support system, at which time the meal-plan is down to their discretion alone. Back home is where all the restricting and other 'disordered' habits are at home too. Without some kind of serious support--with it, even--it's easy for the meal-plan to fade from consideration. Last time I got out, I didn't have support and it was a big train-wreck. This time, you've all heard me talk about how much I love my naturopath and therapist. I don't know the psychiatrist as well, but she is formidably impressive.

Within this paradigm, the meal-plan makes a lot of sense. I have to admire it, even if I kick against it. The aim is to ensure you get enough food, while also eating a variety of food and avoiding calorie-counting or other ways to marshal food into controlled units. Most places use some variation on the "exchange" system, so that you should have a prescribed number of servings of carbs, protein, fat at each meal. Different food items in various quantities can be counted as a serving size for different macronutrients. The one many of us found crazymaking was that two teaspoons of nut butter counts as a fat serving, but two tablespoons of nut butter counts as a protein! And you're not allowed to double-count any one food item; in other words, you take nut butter as your protein and you still need your serving(s) of fat. Depending on what food items you chose, you could end up with a meal hundreds of calories more or less. But that's falling back into the regimented thinking, and since the meal plan's designed with the intent that exchanges are not exactly equal, and that you should pick different items at each meal, and that those items should go together: no beans and guacamole with your oatmeal, now!--the point is to relax and recognize that if you vary enough, it all evens out.

On top of this abandon-counting-but-commit-to-variation twister, depending on our weight, some of us leave treatment with supplements on our meal-plans still.

Three cups of coconut cream and three cups of either juice or full-calorie nondairy milk on top of all that food??
Could you do that?
I don't think anyone could make me get that all in in one day outside of treatment, myself included--often enough, it didn't happen in treatment unless a lot of the solid food was 'exchanged' for yet more coconut cream. But the point is, I don't think anyone really expects me to do all that: they are professionals, they recognize it's much tougher 'on the outside.' Most importantly, they recognize this recovery thing is a process. It's not a linear progression of physical and metaphysical growth to lasting happiness and total comfort around food.

I suspect their hope for all of us is that eventually we can eat enough, not too much or too little, in an intuitive way, listening to our bodies, gradually letting go of the 'exchanges' like training wheels, and that we can love our bodies at 'normal' sizes, and be comfortable eating in any situation.

So, where am I in all this? From what I've already said, I'm sure it's pretty clear that I'm not following my meal-plan 100%. But I have wonderful care providers and they're not worried, because they understand that it's a process.
I think of the meal-plan occasionally, and it helps me to evaluate how what I've been doing instead measures up. If I think I ate too much, running what I ate by my theoretical plan helps provide a reality check. Still how you'd express some of my smoothies in terms of carb/protein/fat exchanges is a question without an answer, and these can be quite substantial smoothies.
Some things slide around. I haven't had three cups of it on any day, but the coconut cream has morphed from 'supplement on top of everything else' to 'insurance,' making sure I got at least a certain amount of nutrition down, to not having it at all, to 'insurance' again. Once it's in the mix as insurance, I find it hard not to think that that's all I should have. This is a tricky dance. Right now, I'm committed to three quarter-cups of coconut cream per day. Three quarter-cups is not three cups, but this is a process, and having the commitment in place is like creating a rung on the ladder up to the trapdoor.

Pitfalls and Trapdoors. I mentioned having fallen through some trapdoors in my previous post. Here's some of what I meant. If you feel you may be triggered, please do not read on.

First big trapdoor: going too long without a snack, after an inadequate meal, hiking, and getting low-blood-sugared to that state of stare-eyed, whirly but still able to hold a conversation. This was a trapdoor because it reminded me of that feeling, that emptiness, that exquisite privateness to which I hadn't yet returned. In treatment, I was always so full that even half that amount of food in a day was still overly filling. Getting back to that reminds me of how easy it is to be in that place, how functional I seem to myself to be when I'm like that. If I feel like I'm functional, it's easy to say no need to eat more.
Second trapdoor: restricting/bipolar one-two punch. Letting dinnertime get too late, working too hard and too fast, paying too much attention to the monsters/hallucinations, and getting to the meltdown point. That nothing was smashed, nothing bigger than a piece of paper thrown, is testament to how much better things are now.
Pitfalls: -Counting calories and doing lots of math to determine portion sizes while preparing a meal.
-Poring over recipe books like novels and either making nothing or making lots and stashing it all in the freezer.
-Telling yourself "No"..."No"..."No"...over and over because you're too hungry to focus but have decreed you cannot have a snack.
-Deciding to eat only three (or four, or whatever, plus carrots) specified foods on a particular day.
-Throwing lots of good food away by various mechanisms.
HOWEVER--throwing some food away is actually a good sign for me because of this:
Danger Sign: -Intense fascination with food that's going bad, has fallen on the floor, is about to be thrown away, etc. Learning to feel ok about eating food that isn't about to be tossed--high-grading--was one of the biggest benefits of the enforced abundance of being in treatment.

There is so much more to write, but this is already long, and has taken me so long to write because I really want to be clear and nonjudgmental and as little triggering as possible. Another post soon with some more of the benefits of being 'inside.'