[QUOTE=Bill3;4402591]Thanks so much for your reply.

[COLOR=Magenta]What are some things that you do you not want to admit?

I don't have a good handle on how much working you can realistically do in the current state of your health. How realistic is it to hold a job steadily now and otherwise move forward as described here?

Some of these issues it would seem could be addressed proactively. But then I don't know what happened at previous ED units, maybe people have already tried these things.

To what extent can your support people be taught that you are not 100% cured when you leave? Or is this something you just have to deal with?

The locked unit: can this be specifically looked at promptly with cognitive therapy? It sounds like a panic-type disorder, has/could a therapist help you with this?

In general I am puzzled about the past issues: here you say that staff at a unit will want you to look at them and you won't want to...but below you say that your T wants you to look at them and you trust her clinical judgment.

It sounds like ED is something of a refuge from an overwhelming fear of failure. What do you think? As long as you are sick you don't have to take your chances in any of the areas of life that you mentioned.

You mentioned your residency, and it sounds like a wonderful time: what happened to the fear of failure then? Somehow you functioned well despite it, you overcame it. How? And what happened after that in your life/career?

So the fear of failure brings up two big issues in my mind: 1. I speculate/assume that this overwhelming fear is rooted in whatever happened in the past, which it seems from what you are saying included a less-than-fully-supportive family who perhaps expected virtual if not actual perfection and did a lot to make failure so feared today, and 2. what bad things do you think will happen if you "fail"?

Thanks!

Good.

I of course read everything you said about your health now, your attending, and about going home. All I can say is: I worry. I worry about whether you can keep yourself safe with what is, admittedly, support well below that which you might need right now.

Thus: I worry.

Then maybe it is safer not to leave?

I completely agree that it was unwise to be allowed to be discharged from ED treatment, multiple times it seems, without addressing underlying issues from the past. Still, that level of wellness is not where you are now. Now you are unwell. What sort of schedule/plan would your T have for working on past issues? How readily could she accept that being done at JHU?



You said above that being scared doesn't motivate you. What about being "scared", if that is the right word, for your patients? You care about them, a lot, when you are at their bedside. What if you bring them to mind when you are deciding, let's say, whether or not to purge?

I mention this to help you see your greatest motivating factor--your greatest incentive--every day, in every moment. Could that happen? Could you see them when you are tired--sick and tired--to help you move forward when every ED impulse is telling you not to?

We could look at the other factors: where are you when it comes to control (behavioural and thoughts); how exhausted and isolated are you?; how intensely do you fear recovery?

Maybe it is the last one? Maybe you have an intense fear of recovery, as discussed above. What do you think?

I would put it slightly differently. I'd say act as if those beliefs are true, even if you don't right now believe them.

This is great!

And while it is a distraction, I don't see it as mainly a distraction. I see this as beginning to rebuild yourself, block by block. Getting back to caring about others in action, in person, getting back to what made you a doctor, getting back to what makes you you. I see this not just as distraction, but as recovery. How did this relationship get established?

Excellent!

That sounds really good. You do know that you are allowed to write about the negatives? It is okay, it is most desirable, to expressin the journal whatever is on your heart at that moment in the journal.

Have you ever done the raisin mindfulness exercise? You examine the raisin in great detail, from all perspectives, turn it over, listen to it, smell it, and eventually eat it slowly and with full attention. You can do that same thing with negative thoughts, feelings: examine them, look at them with great interest and curiosity, rather than try to bury them.

This is still true. Just not so obvious. Your healthy decisions today help tomorrow's patients--and they help your mentoree today.

Really it sounds like you have two greatest reasons: to give yourself a chance, and to use your self to help your patients (as above).

I am glad to try to help you start to find you again.
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I think mostly what I don't want to admit is just how sick I really am and how bad things really are. Whenever anyone asks how I'm doing, my immediate response is, "I'm fine". I really don't want to admit I let things get so far out of control. But I'm not fine, not really. I'm pretty far from fine in reality. I also don't want to admit that I have a "mental illness" because that's completely frowned upon in my family. According to my family, mental illness simply doesn't exist, you just suck it up and do what you need to do regardless of what's going on mentally. Furthermore, I'm embarrassed to admit that I have this problem that I can't "fix" myself. I'm always been a pretty self-sufficient person and I've spent most of my life taking care of others. I really hate to admit that I have something going on that I can't solve on my own. I think those are the main things I'm hesitant to admit.
How realistically is it to hold down a job and try to begin moving forward? I honestly don't know the answer to this one. I have two to three doctor appts/week, plus I'll be spending one full 8+ hour day at the infusion center. In general, I'm weak, tired, preoccupied and often not thinking as clearly as I could or should be. Give me some time to think about this one. I'll get back to you. I really don't know. I'd like to think it's completely doable and that I'm superwoman and can do anything. I do however, have my doubts that I'll be able to handle much right now. It's pretty unlikely I'll be as effective as I would be if I was either in recovery or at least a lot closer to it. I don't know though. There's one more thing I don't want to admit.
I think the whole family believing I'm "cured" once I'm weight restored is just something I'm going to have to deal with. It has been addressed with at least some of my family members at several different treatment centers and they claim to understand and claim their support will continue as long as I need it to, but it just never works out that way. A few weeks into IP treatment, when the immediate, life-threatening danger has passed, the calls stop, the visits stop, the comments questioning when I'm going to go back to work, when I'm going to get married, when I'm going to have kids etc return. Stuff like that. I think it's just kind of the way my dad was raised, hence the way we were raised and is pretty ingrained and not going to change anytime soon. If I were to continue to try to discuss it, they'd likely call me a baby and ask me why I was being such a drama queen and say I was just looking for attention.
The locked unit issue is related to PTSD and a pretty traumatic event. I'm not sure I'll ever be able to deal with it regardless of how much or what type of therapy I get and I haven't ever addressed it and don't want to. I guess I could bring it up in my session next week (the issue with the locked unit, not the event itself, never talking about that) and see if we can come up with some things to maybe help with deal with it so JH could still be a possibility. I have my doubts though. I'm feeling panicky right now just thinking about it.
Regarding the past issues, I could just be projecting. In past treatments, whatever therapist I've had has always wanted to look at root causes of the ED and obviously this entails dealing with some past issues. I'm assuming a new one will take a similar approach. I could be totally off base. And as this is really something I don't want to do, maybe it's something I could discuss NOT addressing with them ahead of time. Yes, my current therapist has brought up several times that I'm going to have to deal with whatever issues are holding me back in order to move forward. However, it wasn't until the session before I went into the hospital that we discussed them on anything more than a very superficial level. I do trust her judgment. Almost implicitly, which is incredibly hard for me to do and if there are things for me to deal with ( and there are), I'd much rather do it with her than with someone I've just met, barely know and don't trust.
I wholeheartedly agree the ED is a refuge from fear of failure. I'm absolutely terrified of failing. I'm so, so scared of failing. I'm so scared of failing that a lot of times I'm scared to even try. You totally hit that nail on the head. If I'm "sick", it's not my "fault" if I don't succeed or don't achieve what I could or should achieve. I couldn't help it, I was too sick. Most of, well all of the time, that's the only time I feel like I'm allowed to get any kind of help of have any kind of attention paid to me, so I think subconsciously I perpetuate that cycle in order to keep getting that attention, negative or otherwise that I think I need. And I think I'm just as scared of succeeding as I'm am of failing if that makes any sense at all. I'm not really sure why? Maybe because then I'll have to face reality that I am an adult, I need to act like an adult and while it sucks that my childhood was spent taking care of my dying mother, father and younger brothers, so I never got much of a childhood, that's over with and done with and I'm never going to get it back and I just need to get over it and move on with my life. As an adult. I'm not a child. I need to stop acting like one. It seems like as long as I'm ill, I'm safe in this protective little bubble. Unfortunately, that's not the case and the real world continues to go on without me and I've missed out on a lot of really great things because of I've been so wrapped up in this world. I don't want to do this anymore. I want to live a real life in the real world with real people.
Residency was a great time. I don't really know what happened. I just know I was succeeding and doing well and in a very supportive environment with wonderful people and I guess that allowed me to be comfortable with who I am or who I was at the time. All this allowed me to take the risks necessary to be successful and achieve what I needed to achieve. In all honesty, I still haven't really figured out what happened. I don't really know what started my downfall. I can piece together parts of it, but not everything. It's a long convoluted story. I'll save the story of my fall from grace for tomorrow. I'm tired. And this would turn into an even longer reply than it already is.
You're right on again with the origins of the fear of failure. My family, primarily my father did expect perfection in everything I did and didn't tolerate much less. I'm not really sure what I'm afraid of happening if I do fail, it's not really a rational fear, more of a fear of not being "enough" as a person, of failing in life, that I'm a failure as a person, a daughter, a sister, a friend. Does that make sense?
I'm sorry, but I'm going to reply to the rest of your comments in a couple hours. I don't feel very well today. I think my electrolytes are off again (and I think I should be going home in 3 days, I'm obviously totally logical )
Thanks again for all your help. It really means a lot. You really make me think. It's good. And I do think it's helping.