A Month in the Country

My therapist asked me what I hope to gain from writing this. What I hope is to give some much needed information to older women, a rising segment of the ED (eating disorder) world. There are loads of blogs and stories for and by and about teenagers and college age students, but hardly any for my age group. Also, there is no residential treatment for adults available in the state of RI. Last, there is almost no information anywhere about what a day, a week, weeks might be. Different organizations have different philosophies. The place I went to fully believes recovery is possible. Their guiding light is a book called The 8 Keys to Recovery.

I’d been diagnosed in 2016. An incident at work was the spark that led to the fire.

In 2017, from June 27 to July 27 I went to a residential treatment program for women with eating disorders (ED), in my case anorexia. I was 59 years old. This is my story from my memories & a diary. While this particular program did not lead me to recovery it has helped countless women.

When I succumbed to a sort of mini intervention by my Dr. , her p.a., my old therapist, the specialist I saw later, my dietician, my husband and my son, I was in fairly rough shape. No one can force an adult to enter into such a program. So we’ll say I went on my own volition. I was very depressed. I was over exercising. I wasn’t eating enough. If you hadn’t known me you wouldn’t have noticed. You would be impressed at how far I ran each day after work and at my ability to do my job well. I myself was in denial. I went knowing something was wrong and to prove to my team that I was a participant in my well being.

I went to my chosen place knowing nothing about what my life there would be. I knew I wouldn’t be allowed to have an I pad but not why (so as not to easily look up calorie counts of our foods, I learned later) and that I’d be eating a lot more than I wanted. I knew there would be both private and group therapy. I knew I wouldn’t get wine with dinner (or ever). Or coffee with breakfast.

Many people who need residential programs have been through it and return. Many know the rules, regulations, the therapists, sometimes each other. I knew nothing. I was as naive as a toddler.

Getting in. I had to have insurance approval, phone interviews, labs and diagnostic tests. At 59 I had to have a pregnancy test. Once you have those tests you have 2 weeks to enter. If you miss that deadline you have to do them all again. My form had a transcription error and I nearly lost my mind, but it was corrected and I was going.

When I arrived, on a rainy day, my husband and son came in with me. The house was pretty. It looked like a b & b. We all used the bathroom, which had to be unlocked. I needed an in person assessment and for a couple of hours until someone was free to do that, I was in limbo. Andy & Noah drove home.

The only rule they bent on my behalf was to give me my own room on the top floor. I didn’t know then that one started on a lower floor, always with a roommate, and ‘earned’ their way to the top floor. My room had a bathroom with a mirror, a privilege I hadn’t yet earned.

A recovery coach (RC, available all day if you want to chat), showed me my room and carefully unpacked everything in my suitcase. My nail clipper was removed, my little powder & blush because they contained mirrors which could be broken and used for self harm, my metal ruler I’d brought for drawing – also potentially dangerous, my flip phone. I was not permitted to have the embroidery I brought, no needle or scissors called sharps. It never occurred to me to use any of those items to hurt myself but of course, now it would.

Meals. Three meals and three snacks a day. For the first 24 hours you’re allowed to leave a portion of your food uneaten. After that you have to eat every crumb, clean your plate. If you don’t you have to drink Boost, a calorie laden thick milk drink. Usually an RC and a therapist are present at each meal and eat the food with everyone. New clients are seated next to one or the other. There are name cards at the big table. The meals are timed so no one eats too fast or too slowly. You have to drink at least one 6 oz glass of water with each meal and you aren’t allowed to have more than two, so as not to ‘water load’ to change your weight (I learned much later). No table cloth, not too many napkins with which to hide food, I learned much later. After dinner you’re allowed hot herbal tea instead of the second glass of water. I don’t like tea. Someone that night asked me my favorite book. “Anna Karenina”. “What’s it about?” she asked? “I haven’t heard of it.” It was at that point I wanted escape or death or both.

At most meals, not snacks which are shorter, they play games to distract from eating (I learned later). One called Essence, one called Target or Home Depot, one called Wrench or Rabbit. At breakfast we were to take turns reading the horoscopes out loud, from the Boston Globe. For the first three days I barely spoke. I did not read the horoscopes or play the games. Usually I cried or sat in silence. Or planned my escape. Or thought about the revenge I would extract on my therapist and my dietician.

Pretty soon after arrival you meet the house dietician (whom I adored) who talks with you about what you really can’t or won’t eat (no meat or fish for me). You meet the nurse. You go for labs often in the beginning. You meet your house therapist. You are supposed to get three sessions a week. Two half hour and one hour but that didn’t always happen.

Every day rules & routines. Everyday except Sunday you go to group. It was at group on my first Saturday that I opened up. I still cried all the time but after I spoke I felt more at ease with the ‘kids’ who ranged in age from 18 to 27. Most were around 20. They were a smart bunch. You are under obs (observation), a nightmare for me. It means you can only use the bathroom with the door ajar and an RC or therapist standing just outside the door. You cannot flush without them taking a look (to assure you haven’t thrown up, I found out later). You are awakened each morning between 6 and 6:30 to have vitals. Then you put on a paper gown to be weighed. You can take a shower (no shaving because razor) and dress and you need to be downstairs by 7:30 for breakfast. Once downstairs you are not allowed back in your room for any reason until bedtime at 10, so everyone comes down with a bag that has a notebook (no spiral bindings which can be used for self harm), a sweater for weather changes, book, whatever you think you might need. The bathroom door in your room is locked. You are not ever allowed to be truly alone. They find you. You are not allowed to stand (a behavior, the term used in ED world) to try to burn calories. You aren’t allowed to exercise unless it is the prescripted 15 minute group walk, done at a nursing home pace, or the once a week yoga if you’re cleared for it after lab work. Once a week you go out for a meal as a group. You have to eat as much as the dietician tells you to eat. After the restaurant you go to an ice cream place where you have to get dessert which you have to complete. There were pizza nights. Once a week we had a drugstore outing (for shampoo, deodorant, etc) with a Starbucks trip for decaf. On Saturday mornings we went to Starbucks for REAL coffee and then a group outing. I went bowling, to a bookstore, to an urban beach (no swimming allowed though we were permitted to walk a little in the icy cold water), to an awful area with mini golf, a petting zoo, a batting cage (not allowed), pinball machines. Nearly every evening there was a ‘special’ group, about mindfulness, or when we last felt able to eat joyfully or some such thing.

Contracts. On Tuesday we got weekly contracts. We could ask for privileges such as reduced or no obs, more exercise, the use of your phone for music, sharps, a pass for an outing. We were to set goals, the most difficult part for me. I always wrote that I wanted to want to get better. All the therapists were present. Your therapist would read your requests and goals out loud and tell you right then if you got what you wanted or not. It was very cut and dry.

Good times. There were many. We got to know each other and gave each other support. We laughed and cried together. We listened to music in the kitchen (you have to earn the right to be in the kitchen). Many nights we watched Gossip Girl which I’d never seen but they had, many times. We weren’t allowed to watch episode 9 which had a binge segment. We did yoga outside and it was there I learned to love yoga. We had a spa night. I had lots of time to read my book, The Wind Up Bird Chronicle. Eventually I was able to sleep. Eventually I was allowed to shut the bathroom door.

What went wrong. I became a little too close with some of the residents. I wanted to fix them and lost focus on fixing myself. I started to notice little fissures between some of my fellow clients and there were a lot of staff changes that coincided with my stay which was difficult and jarring. The anti depressant I tried there didn’t help me. I started to be afraid to be fully truthful when I found out that if you do something you shouldn’t (I did) you might lose a privilege, which for me could have been dreaded obs and the unlocked open bathroom door. I also found out there was a great big book where the RC’s and therapists would write comments about something you might have said or done or if you seem especially depressed. The comm book.

You could sometimes have visitors but they kept you so busy it was hard to plan them. My son and my husband came a few times. No one at work knew where I was, only that I was on medical leave. Two different friends came. You could receive mail. Packages had to be opened by staff, lest there be drugs, razors, triggers (sexy clothing?), outside food. Moms, dads, brothers came, families came, dogs and cats. We had a therapy dog twice. (Heaven). You could sometimes check e mail, which is when, only at first, I would plead with husband to get me out or tell my therapist I would never speak to her again. (I did speak to her, of course). There were lots of assignments: letters to your body, letters to ED, letters to family, which you had to read to your therapist and sometimes in group. You had to write a ‘life map’ and read it in group. People cried, there were truly sad and tragic stories. Mine seemed hum drum except that my mother was losing her mind to dementia. I told everyone about the work incident.

Cheating. It is hard to break rules but people do. I did. You can ask to go on an outing on your contract (after you’ve been there for a bit). The initial outings are usually during snack and you have to assure them that you will have the snack. You need to tell them who will be with you, where you’ll be going and you have to be back at a particular time. They need to be able to reach you. There was a store I wanted to visit. We parked a fair distance away and walked. Broken rule #1. I bought lots of pens. We walked back and where I said I would buy a snack, banana, yogurt, I did not. Broken rule #2. I was so happy. We got back on time. You meet with the nurse who sees what you bought (my pens!), if you have anything you shouldn’t. They ask you what you had for snack and where you bought it and how you felt about the whole thing. I lied like a sociopath. I said I had a great time (true), that I hardly walked (false), that I ate my snack (false). I never confessed the truth to any of my new young friends or my therapist or an RC because to tell one was to tell them all. I felt guilty. On every other outing I stuck to all the rules. Earlier in my stay I would dance around (quietly) and do pointless calisthenics, another broken rule. I wanted to confess, but one time during group and later the same day at the contract meeting a client’s lie had come to the surface in kind of a humiliating and sad way. She lost privileges and became depressed and ashamed. I was terrified of consequences. I had an exit date as I had to return to my job the Monday after getting home. Unless you have to, don’t do that. Leave yourself extra time. Stay longer if you need to. Go to a step down program.

Leaving. By the time you have a release date, you have passed markers. You have shopped for your meal, prepared your own foods, told everyone your story. There are pages of forms to complete. You get your phone back to make appointments with your therapist, your dietician, your doctor. You must have a plan for your first day back in your life on the outside.

Graduation. At this residential program there is a ceremony. You get to choose a song (mine was We’re Going to be Friends by White Stripes which I can hardly stand to hear now). You talk about recovery and what each person means to you and they tell you what you mean to them. In our group, which was or seemed very close, we also wrote each other letters. I was happy. But ready to leave because I had developed trust barriers with some of the staff and there was a little mean girl behavior too. I wanted coffee and wine and walks.

The worst time. After my ceremony all us girls and women sat on the big porch like cats. I was working on my embroidery, by then allowed to have sharps. There was a huge, beautiful thunderstorm. Then, the director poked her head out and said we were having a group meeting with the entire staff and all the clients. I had a terrible sense of what might come. It felt similar to the workplace incident and I shut down. As it happened the staff filled up one side and the clients the other. The director sat in front of us. There had been spats among some of the clients with their therapists, some complaints about a nurse and an RC. Also, the staff felt like we were talking behind their backs, making fun of some of the process. The plan was to have an open and frank discussion. Instead, none of the clients said anything. The staff kept trying to raise issues and make us feel safe but I did not feel safe. It was my last day. I felt like this was a wrong way to handle their concerns. I crawled into myself. The meeting ended. I had not cried at all since the first week but I started to cry when I went back outside before the gong for our meal. This is when I learned that a trauma doesn’t have to be a rape or a death or abuse. For me it was the work incident and this meeting brought it all to the surface, but since it was my last day there was no way to understand what was happening to me and no one to help me through it. I had my last dinner, seated next to the dietician I loved. I cried intermittently all that evening. The kids were so sweet. The next morning before group everyone came to hug me good-bye. I went onto the porch and waited for my friend to come for me. The first place we went before getting on the highway was Starbucks, for coffee.

After. I crashed. I did see my doctor and my therapist and my dietician. I did have a plan for my first day home. I tried to reach out to my closest friend in residential, who left two days before me but she sensed that I was struggling and she cut me off.

Now. It is 2020. I am not recovered. I smoke cigarettes and have some other behaviors I didn’t have before. I don’t exercise insanely. I don’t eat enough. I have a different therapist, same doctor and dietician. There was talk of going to a different residential program with a different philosophy but I can’t face it. There was talk of going to an I.o.p. – intensive outpatient program which is like residential but you sleep at home. There is COVID now so anything other than residential is virtual and I just can’t. I left my job. I am a full time artist. I am taking a different anti depressant which works. I admire each and every person who seeks help and knows when to step back through those doors. In many cases parents encourage their children get to go there. Both my parents have died and at this point in my life I can’t imagine stepping through those doors again. My therapist hasn’t given up on me. An eating disorder is a mental illness. I have lost friends who feel I should be my old self by now but I have some great friends who have remained with me. I have my husband and my son. I hope this helps even one person struggling with this affliction.

This is the embroidery I finished while I was in the residential program.