![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by Racer on March 19, 2004, at 11:09:08
Since I'm drowning in self-doubt right now, I'm gonna have to frame this in an example of what I'm trying to convey. My question is about insight, and whether or not what I see as insight into my own condition is real or imagined.
When I first saw my pdoc, I stated that I'd had an eating disorder. From my perspective, it's true: I restricted food to a ridiculous degree, experienced my body as humongously fat when in fact I was underweight by any standard and others were telling me so, and exercised to excess. Even while that was going on, though, I was aware -- somewhere inside me -- that what I was doing was not normal, not healthy. I was aware that something was wrong -- and even aware of what it was, aware of its name -- but I couldn't stop it and couldn't internalize that reality. It was like looking in through a window, in the rain, and seeing a warm, cozy parlor -- but not being able to find the door. The pdoc said that I didn't fit the DSM IV criteria for anorexia. Why? My periods didn't stop. I weighed between 75% and 80% of what would have been a healthy weight for me. I was weak, bruised easily and often, fainted pretty frequently, and thought I was such a failure for being so fat -- even though I knew that I was not *really* fat.
Now tell me this: did I have legitimate insight into my condition? Does that realization that something was wrong constitute insight, or is it some weird pathology that prevented me from having real insight? Does the fact that I knew my perceptions were flawed mean that those perceptions were not real? Were they factitious? Or did I have the initial insight required to recover? Were those truly legitimate insights into my condition, insights which -- had I had access to help -- would have aided in my recovery?
I guess what I'm asking is whether we're capable of having legitimate insights into our conditions, or whether our belief that we have insights is in itself pathological?
Thank you!
Posted by Dinah on March 19, 2004, at 11:24:00
In reply to Question about insight, posted by Racer on March 19, 2004, at 11:09:08
Of course you can have insight into your own condition! You live with yourself 24/7. Your pdoc sees you how often?
And not meeting DSM IV criteria for anorexia doesn't mean you don't have a problem in that area. It just means you don't meet predetermined arbitary criteria to be diagnosed with something.
I'm stretching to say I meet the diagnosis of *any* DSM IV diagnosis, and my therapist agrees that I don't fit neatly into any box. But that doesn't mean I don't have significant emotional/brain problems (and my therapist agrees with that, too!).
Posted by DaisyM on March 19, 2004, at 15:25:20
In reply to Question about insight, posted by Racer on March 19, 2004, at 11:09:08
I agree with Dinah, of course you can have insight into your own condition. Imagine a medical condition...the flu. You KNOW what the flue feels like, looks like, etc. Now most people don't really have the flu, they have some sort of stomach upset (food poisining) etc. Does it matter that they describe it as the flu, vs. some other name? We might even know what to do. But, we might be too sick to do it. We need help. Or, it is "worse" than other flus we've had before so we don't know what to do about it.
Just because you know what is wrong, or even that something feels wrong, doesn't mean you know how to make it better. This is especially true with behaviors that get entrenched. We should stop, but we can't seem to get ourselves too.
I think you have to be open to additional interpretations of things, but that doesn't make the conclusions you reach on your own wrong, or bad or useless. You do know yourself better than anyone.
I would even venture to say that what you think about your own condition is as at least as important as the condition itself.
Hope things start looking up soon.
Daisy
Posted by fallsfall on March 19, 2004, at 15:32:19
In reply to Question about insight, posted by Racer on March 19, 2004, at 11:09:08
Yes, we can see important things about ourselves. And I think that you have. You know how you behave (like you are fat), and you know the facts (that you are not fat). That is incredibly valuable.
Did your doctor refuse to work with you on "anorexia" issues? Or were you upset with not getting the diagnosis that you expected? As Dinah, said, the diagnosis are very arbitrary. If you have significant "traits" but don't meet the diagnosis, your doctor should still work with you to address those traits.
Keep looking at yourself and trying to understand. That is really important.
Posted by terrics on March 19, 2004, at 17:16:04
In reply to Question about insight, posted by Racer on March 19, 2004, at 11:09:08
Sounds Legitimate to me. And yes I think most of us have some pretty good insight. Not all though. terrics
Posted by Racer on March 19, 2004, at 17:19:51
In reply to Re: Question about insight » Racer, posted by fallsfall on March 19, 2004, at 15:32:19
Nope, The Good Doctor EyeCandy will not address the issue. I tried to bring up to him a while back that I was concerned about my weight. I told him that I thought I needed to gain some weight, that I was not comfortable being so close to the danger zone and wanted a little padding for protection. He didn't just not engage in any sort of discussion of the matter, he threw himself into an emphatic, "NO!" Telling me that my weight was fine, that I shouldn't worry, etc.
Now, no matter what you call it, I've slipped again. I *know* from my scale that I've lost weight, but I am experiencing myself as hugely fat again. Even though I know that the scale is telling me something different, I look in the mirror and see huge thighs, flabby arms with droopy skin, and a great, huge belly hanging out. It doesn't matter that others are telling me that they're concerned with my weight loss, it doesn't matter that I recognize that there are dragons here, it doesn't matter that I have some clue about what's going on. And, no matter how much I try to tell myself that I have to eat more, or that I have to stop thinking about what I eat, I still find myself getting secretive about my eating, avoiding eating with anyone else around, etc.
My mother and I went out for something to eat to celebrate St Patrick's Day. Well, OK, we went out to celebrate getting a valve job done on my car, but it was on SPD. We went to Chevy's, I ordered a Margarita and chicken tamales. I love tamales, and I love margaritas. I drank less than half the margarita -- alcohol and empty calories -- and ate a bit more than one of the three tamales. My experience of it was that I was weak and lacking in impulse control for eating so much, and it made my stomach hurt a lot. My mother was appalled, so much so she actually said something was wrong, and that I was too thin. For my mother, that's a huge acheivement. She usually avoids talking about any of these things, because if she mentions them she might have to think about them and admit them. She's terrified of doing that. For her to say, out loud, that I'm too thin and something is wrong is very, very much a sign of progress and deep distress. And I'm feeling fat and self-indulgent.
Oh, well, here's the other side of the coin: I want to get help, but it won't be easy to help me at this point. They can't hospitalize me, because I won't be able to eat in the hospital. Short of that, they can maybe examine some of my emotional responses -- if they find me another therapist -- but there's not much they can do in the current situation. Sucks. A lot. And I know that I could stop it, if I were just strong enough.
Trust me, you don't want to be me right now. But thank you for asking that question. You're right, what's bothering me is not the philosophical question of how real the insight we have is, what's bothering me is that I don't feel as if I'm getting help and I do need it. It's as if he's absolved himself of any and all responsibility for that part of me, just because I don't fit into a preformed mold that he's looking for.
(Short story that applies from my view: as a teen, I injured my knee. Orthopedist was planning surgery, after several exams. He was telling me about what to expect when I showed up for surgery: "Now, you'll have to stop shaving your legs about two weeks before the surgery, because if you have any nicks or scrapes or cuts we'll have to cancel it..." This man, who had examined my leg minutes before, had not noticed that I did not shave my legs. He was so caught up by his own preconception that all women shaved, except those hairy legged feminazis, that he never even noticed the full complement of thin, fine, light brown hair covering my lower legs. That sums up my perception of doctors, and explains my belief that men do not see women.)
Again, you slammed me into a new perspective on this and I'm very grateful.
Posted by Racer on March 19, 2004, at 18:34:23
In reply to Re: Question about insight » Racer, posted by terrics on March 19, 2004, at 17:16:04
> Sounds Legitimate to me. And yes I think most of us have some pretty good insight. Not all though. terrics
Can you explain a little more fully? I am guessing I understand what you mean, but it would help if you could be a little more specific. My understanding muscles are pretty flabby right now, every little thing has to be spelled out pretty clearly for me to understand it.
Thansk for responding ,and sorry to ask for more
Posted by fallsfall on March 19, 2004, at 20:31:15
In reply to And therein lies the rub... » fallsfall, posted by Racer on March 19, 2004, at 17:19:51
Please, please find yourself a therapist with experience with eating disorders. Please?
You are ready to work on this problem. Now is the time to do it.
There was an eating disorders unit in the hospital where I've been. It is populated mostly by High School students. But when I was there on the General Adult Psych unit, there was one girl who was (maybe) 21 in the eating disorders program. She slept on our unit and did the morning and evening checkins with us. Everything else was done with the ED unit. She was the nicest person you have ever met, and she worked SO hard to understand why she had issues and to address them. There was one day when it was somebody's birthday. I talked the kitchen into giving us a cake for the celebration. She was on the unit when we broke out the cake. She took a regular sized piece of cake, and she ate the whole thing. She was so incredibly proud of herself. It was a joy to watch her. We had heard, day after day, how hard she was working and how much insight she was getting. This cake was like the culmination of her program. And she just lit right up.
I wish this for you.
Please find someone to help you. This isn't the kind of thing you can do by yourself. Don't feel weak for needing help, and for heaven's sake, don't take Dr. EyeCandy's opinion as being worth anything. You know you are heading into dangerous waters - please find a life raft.
Posted by Racer on March 20, 2004, at 1:15:14
In reply to Re: And therein lies the rub... » Racer, posted by fallsfall on March 19, 2004, at 20:31:15
Well, that's a wake up call. I read about the cake and shuddered.
Then again, I'm not in my twenties -- I'm a semi-respectible middle aged woman. The thought of going into a program with kids really scares me, especially since I've taught for so long it's second nature to me. I get into an environment where I have to speak in front of a group, and I can hear my Teacher Voice start. Doesn't matter if it's adults, kids, what. I Am Teacher. Groups are hard for me, because I find myself explaining things for the facilitators, making notes about how they can improve their skills, etc. And, in a case like this, I'm totally nuts! I don't like skinny women, so why the hell am I so caught up in how fat and sloppy and disgusting I am? I can tell everyone that thin is not the definition of beauty, that beauty can be thin, or plump, or angular, or curvey. Yet, I look in the mirror and see a monster.
I dunno. When it gets this bad, it's really hard to find a reason to keep trying. And having Miss NotReallyBetterThanNothing for therapy just isn't the right answer. I can't take this much longer.
Thanks for telling me about that, though. Even if it seems as if I'm not being receptive to you, often that's because of my state of despair. It doesn't mean that the support you show hasn't registered. I really has, and it has made a positive difference for me. Thank you.
Posted by Pfinstegg on March 20, 2004, at 11:24:38
In reply to Re: And therein lies the rub... » fallsfall, posted by Racer on March 20, 2004, at 1:15:14
Hi Racer... I haven't posted to you directly before, but have been following what you have been saying here and on 2000. You seem to have made so many wonderful gains over the past year: I have been admiring your courage and persistence more than I can express. But lately, I have been feeling distressed that you don't seem to have the right kind of help and support now to go on building on what you have already accomplished.
I personally think it would be impossible to be in a group with 20-year olds and feel that you could share safely and give and receive understanding anywhere near equally.(especially with things like body dymorphic issues- if that's wht you have in addition to the ED part- I am just guessing here). And your THERAPIST! Do you have any options for going to another one? It would be wonderful to hear that you were able to go and interview several therapists and choose the one who seemed and felt best to you.
Posted by Pfinstegg on March 20, 2004, at 15:09:05
In reply to Re: And therein lies the rub... » Racer, posted by Pfinstegg on March 20, 2004, at 11:24:38
Racer- I said I had read your posts in "2000", but actually, I hadn't for about a month. I just did, and now have a much better idea of what you're up against. You are much smarter and more insightful than that gang you've got! Even with your difficult financial situation, do you know, FOR SURE, that there are'nt other therapy options available. I somehow have the idea that you live somewhere around San Francisco. What about investigating finding a therapist in psychoanalytic training? They see patients for VERY low fees, and, although they are not experienced, and are learning, they have to have a degree in social work, psychology or medicine (with a psychiatric residency behind them). They 're intensely supervised by tremendously talented and experienced training analysts.
I'm just bringing this up because I am having such a wonderful therapy experience with a psychoanalyst- very interactive - no blank slate c*^%. I know it's not what most people do, but I, personally, am so thrilled to be able to do it.
I love how feisty you are just now, but don't be so feisty tht you forget to have an open mind towards something new, also
Posted by Racer on March 20, 2004, at 17:06:40
In reply to Re: things I didn't know.. » Pfinstegg, posted by Pfinstegg on March 20, 2004, at 15:09:05
Thank you for posting to me. And it is flattering that you've read my posts. Thank you for telling me.
Anyway, I've done a fair amount of research into my options, and I can safely say that this is what I'm stuck with for now. My husband just *finally* got a job, but it's a Canadian company just starting up here in the US, so they don't have benefits in place yet. They'll get to that sort of thing just as soon as someone gets enough time away from other 'real' work to deal with the side issues -- like benefits and getting telephones... Seriously, how much faith should I put in a company that has its employees bring their cell phones to work until they can get around to ordering telephone service? And their financial plan shows that, if they're not in the black within -- I think it was six months -- they're just going to give up on a US presence. I don't have any faith at all that we'll be getting health insurance through these people. If we do, though, then I'll be able to go to someone with a clue. So, I'm holding on to that thought to get me through this.
In the meantime, I've done the following to try to find alternatives:
Looked online, where I found a few possibilities. I called each, and found one that had low enough rates that I could sorta manage it. She turned out to be a really bad match, though. She enjoyed me, if you know what I mean. It was more like a coffee date than a therapy session, and that didn't work for me. The others were out of my price range.
I called every pdoc and psychologist listed in the yellow pages, asking if they accepted self-pay patients without insurance, and did they by any chance have a sliding scale? One doctor was willing to see me, and he turned out to be a real winner: he missed appointments, didn't respond to pharmacy requests for refill authorization on my meds, etc. NOT acceptable.
What I haven't done, yet, is call NAMI's local chapter. I'll try that on Monday or Tuesday. noa suggested it, and it's a great idea. I will try that.
And I'm not so much feisty right now, as desperate. See, when I get suicidal, I don't make a plan such as, "well, I'll get a gun..." I make a plan that says, "here are all the things I haven't tried yet, and once I've done them all without getting help, then I'll know that I have to do this." So, what looks like 'getting better' to people who don't know me well, is actually a sign of getting much much sicker. I'm falling so far back, and it's very distressing.
Thank you again for your attention. It is nice to know that I'm not as invisible as I feel right now.
Posted by Pfinstegg on March 20, 2004, at 21:49:10
In reply to You flatter me » Pfinstegg, posted by Racer on March 20, 2004, at 17:06:40
Gosh, I'm so sorry things are so frustrating and hard. It sounds as though the right therapist is just crucial- and as soon as possible. I can see you've been looking very hard, though, and without success so far. I second Noa's idea of asking for referrals through NAMI. I've heard that they have really come through well for people when finances were the limiting factor. And it might be worth checking your local psychoanalytic training institute. I know no-one really considers doing that these days, but analysts really know a lot- they are almost always involved in the training of all the other types of psychodynamic therapists.
Posted by Racer on March 20, 2004, at 23:05:12
In reply to Re: You flatter me » Racer, posted by Pfinstegg on March 20, 2004, at 21:49:10
Is probably Stanford or thereabouts. Too far for me to go regularly right now, but I will check if NAMI doesn't come through with anything.
Here's part of my problem. Things have become so adversarial with the treatment team members that I have access to, that I feel as if I spend more energy fighting them than I do working towards recovering. And all that energy is coming from someone who has no energy to spare for anything beyond not falling completely apart. The agency uses a case manager to coordinate care, but mine says that all my needs are being met, all I have to do is stop resisting and start working in therapy, and take the meds the doctor prescribes without asking questions. He has told me flat out that he doesn't see that he has to do anything at all for me, but if I'm unreasonable enough to contact him, he'll take it on a case by case basis. Needless to say, I don't plan to call him -- despite the fact that he's then been successful in his job, to all appearances. The therapist shuts me off if I try to tell her my side of anything, and keeps telling me that she sees me as having all these different Axis II diagnoses, all these personality disorders, etc. When I say, "no, I don't think that's accurate," that's just a sign of my pathetic lack of insight. She won't give me credit for any of my life's acheivements, because they're so obviously not true. (I mentioned that I was capable, using a professional achievemtn to illustrate it. One year, I worked in Volunteer Development for a non-profit. This organization relied on very busy professionals during their busiest time of the year, so we were usually understaffed. The one year I worked on VolDev, we had more volunteers than we needed. The only time that ever happened in the entire history of the organization. I did not say that it was solely my doing. I just happened to work in that area that year. But I was involved in it, and I did contribute a great deal to that outcome. Telling me that it's a personality disorder to say that I'm not totally worthless? That, my friends, is invalidating.) So, at the time when I most need help, I have the Anti-Helpers to deal with. I need an advocate, both because I don't have the gumption anymore, and because anything I say is met by, "but you're suffering a mental illness, so you're wrong..."
The other problem is Bootstrapping. I do it to myself. The eating is a great example: I know, "all I have to do is eat more, so what good will it do to talk to anyone about it?" So, I know the problem, I know the solution ("eat more"), I know that it's a problem that requires professional help, and I can't talk to any of the alleged professionals about it because they've already told me that all my needs are being met and I'm unreasonable and I have to do it myself and so on. So, they're telling me the same things I tell myself, so I stop talking. That sounds as if I mean within that situation, but it's wider than that. It's hard for me to talk, because I don't feel as if anyone's listenign to me. Mind you, I can -- mostly -- communicate in writing. But even to my husband, I'm shutting down conversations, etc. I finally told him today that he needed to back the hell off, especially with bringing home foods he thought I would eat, because I needed professional help, which he couldn't give, but if he wanted to help he could try somethign like vacuuming. That led to one of those, "oh, so it's all my fault" talks, with me saying, "don't listen for the criticism, try to hear what I'm telling you: I"m in overwhelming pain and distress, and the few things that you could do, you won't!" Sure, there's probably criticism in there, but believe me it's deserved when he heaps more pressure on me, then rejects my efforts. I end up not really seeing any reason to keep trying, and no reason at all to keep trying to talk.
So, does any of htat make sense? (that's another thing: with both the case manager and the therapist, I ask them that. "does that make sense?" or "Can you tell me what you just heard me say?" The answer to the first question, no matter how clear my statements, is invariably, "No, that doesn't make any sense at all." The second is like being first and last in a game of telephone: what they say back is totally different from what I've said. And you know what? What do you understand from what I have written here? That's right. I really can express myself pretty clearly. It really and truly isn't me that's the problem here.)
Anyway, I'll call NAMI, and maybe even get up the gumption to try Stanford. If I have the energy by then. Thank you for everything.
Posted by Pfinstegg on March 20, 2004, at 23:33:19
In reply to Nearest that I know of... » Pfinstegg, posted by Racer on March 20, 2004, at 23:05:12
The thing about these so called *helpers* that you have is that they're probably more used to dealing with people with diagnoses like schizophrenia. So you, by comparison, would seem to have nothing to complain about! Also, this idea about piling Axis 2 diagnoses on you- what a waste of time!: quite a lot of mental health and neuroscience experts don't even think the DSM IV distinctions are valid or helpful any longer. The newest thinking seems to be that most of the disorders are "disorders of affect regulation". They are real, brain-based disorders, with origins in various childhood traumas, which wax and wane depending on how much stress vs. support and understanding we all have, and which can respond extremely well (and permanently) to the best therapy and medication. This includes *borderline*, which my analyst, for example, no longer uses as a diagnosis, even though he sees, by preference, people with difficult problems.. As you point out, you are very high-functioning, even though you have a lot of inner pain to deal with. Me too.
San Francisco has more than one analytic institute, I think. I'll look them up and post what I find. As it happens, I use the couch most of the time, but many analytic patients do not. You don't have to. You also don't have to go every day: I go twice a week. All the modern analyst are interactive and *relational* in their work- no different from the best therapists who have been described on this board, but sometimes with more training, and more preparation to be successful with patients who used to be called borderline, but may be called Complex PTSD now. Do not be worried that you will run into a horrible "blank slate" if you decide to do it- those have all been retired!
Posted by Racer on March 20, 2004, at 23:48:19
In reply to Re: Nearest that I know of... » Racer, posted by Pfinstegg on March 20, 2004, at 23:33:19
If you do find something (closer to San Jose, by the way) please feel free to email me the information at babbler39 at excite dot com. I'd love to have other options -- or at least know that I do have the options.
Thank you so much. You're right: it mostly takes support and adequate meds. Once i have those, I can function pretty well. (And it doesn't help that my background is nonprofits. This is a non-profit, they do a lot well, but they've got some of the usual non-profit dynamics going on. I swear, cross my heart and hope to -- you know -- that one day I'm going to make a series of posters for non-profits. The cornerstone will be one that says simply, "Because you are Doing Good, does not absolve you from the responsibility to do it WELL." I think that is getting lost with these people.)
Thank you. Every little bit helps, and anything I can cling to right now is literally keeping me alive.
Posted by Pfinstegg on March 21, 2004, at 0:19:14
In reply to Re: Nearest that I know of... » Pfinstegg, posted by Racer on March 20, 2004, at 23:48:19
There's just one in your area: The San Francisco Psychoanalytic Institute, at 2420 Sutter st., S.F., 94115.
You can e-mail them at society@sfpi.org. You can also look them up on google. They have a brief description of the adult low-fee program. They describe the therapists as "experienced psychotherapists in training to be psychoanalysts", which sounds pretty good compared to what you have been dealing with. If they accept you, they describe the fees as "low and flexible". You can apparently go to someone in SF, East Bay, Marin and Sacramento, as they have people in training in all those places. Being from the East Coast, I just don't know if any of them are convenient for you.Why not investigate them and see what you think of their abilities- and whether they offer you someone who feels like a "good fit". That helps SO much!
Posted by Racer on March 21, 2004, at 11:40:37
In reply to Re: Nearest that I know of... » Racer, posted by Pfinstegg on March 20, 2004, at 23:33:19
I want to find something that says that, to print out and take in to this chickiebooboo. You know, any exploration that says that maybe personality disorders from Axis II are as useful as bicycles for fish.
If you've got some links, bring 'em on, baby!
Thanks so much. I can't express how much that concept alone helped me.
Posted by Pfinstegg on March 21, 2004, at 21:59:33
In reply to Got any links? » Pfinstegg, posted by Racer on March 21, 2004, at 11:40:37
These ideas came from "Affect Regulation and the Repair of the Self" by Allan Shore, published by Norton in 2003. It's a book, so it's a bit cumbersome. however, I think you could google for "Dr Shore-Affect Regulation" and probably come up with an article. He's published a lot recently
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