Nice online LD, etc.

     Last night I left a rambling, tearful message on my looney doctor's voicemail. I said that i didn't want to see him anymore because the last 2 times I saw him he brought up LIPOSUCTION. The first time, we somehow got on the topic of plastic surgery (it was during one of those general chatty sessions when we discussed non-me related things). He asked if I had ever considered plastic surgery for myself, particularly liposuction. I was a bit flabbergasted at the time, but didn't make a big deal of it and the session continued (mainly I didn't let it sink in immediately). But for the next week I was consumed with the uneasy/disturbing realization that my psychiatrist had brought up liposuction with me. He is not an E.D.-focused psychiatrist, and in fact once made that comment that E.D.s are just the modern means for young women to express their misery, as they did with "hysteria" and fainting back in Freud's time. So I try not to discuss E.Ds. too often, but sometimes I mention that I struggled a lot that particular week. He is a really great guy, who is sincerely trying to be helpful, and he's very kind. But since I started seeing him last year, every time I bring up how I feel fat and disgusting, he suggests that I diet, and that suggestion, coming from him, breaks my (fatty) heart.
         The week before he made the first lipo comment, he had recommended I try some kooky-sounding diet where you eat 500 calories for a few days a week, and eat whatever else for the rest of the week. And a few weeks ago, he said, "There's no medical reason why you cannot lose weight." 
        Anyway, last night I was so upset about this on the way home. I walked over the bridge as usual, then sat numbly in the park in Long Island City for a while. At first I was thinking of calling him from there, but I there was so much train noise that I couldn't hear myself think. So I took the train home, and called him as I was walking from the train station to the house. I remember telling him that I was so upset at our last session because he suggested liposuction, and he has also been suggesting diets to me every time I start to tell him how fat I feel(am?). I started crying as I was saying this, which was really surprising. He called back about an hour later and left me a message, which I'm too chicken to listen to. I'm so chicken. But I don't regret saying what I did; actually, as soon as I left the message, I felt FREE and light- like a great weight had been taken off my shoulders (now if only I could take a great weight off my abdominal region!).
      

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 UPDATED: About the time that the above drama was happening in my mind and heart and body, I reached out in desperation to a LD who runs a brilliant blog on ED treatment. I have been reading his blog for years. I even had an appt with him once, circa 2008. He just happened to have  had a cancelation that day, but he did not have any regular treatment times available and offered to refer me. He said that I had "never been treated" (based on what I told him about my treatment up to that point). But after that one meeting in 2008, I continued to follow his blog, which is brilliant- if there is any one in the world who understands EDs, and possibly can cure them, it is this man. So in desperation last June, I wrote him (anonymously of course), and he was kind enough to reply. Here is the exchange.

 

Dear Dr ____,

I am an avid reader of your blog- I think your understanding of eating disorders far surpasses anything else I've ever read on the subject. For the past year I have been in therapy with a psychiatrist for the treatment of depression. I have a long history of bulimia (or ednos- I haven't checked the dsm v yet so I'm not sure which if any ed I meet criteria for). I have told this doc about my ED, but he seems kind of not too interested in hearing about it; he really just focuses on mood disorders. That's better than nothing tho- it's not easy to find a psychiatrist who treats eds. I like him a lot generally- he's young, kind, very smart and he trained at some great institutions. But every time I bring up the fact that I feel fat, and that these thoughts are all-consuming and drive me to despair, his response is to give me weight loss advice. I am much heavier than I'd like to be, but I'm still within normal bmi. But he says things like I would feel better if I lost 10 pounds, that I should try that new diet where u eat 500 cals two days a week...  And the last time I saw him he suggested liposuction. Anyway, I guess my question to you us, is there any reason that you can think of that a well-trained smart psychiatrist would say these things to a pt with an Ed?  I mean, I'm trying to figure this out. Is there a tx protocol that I just don't know about? It seems wrong, well, at least, it makes me feel even worse. Are ppl supposed to feel really bad like this before feeling better? I just am trying so hard to understand this. Thank you for reading this!

HIS RESPONSE:

Thank you so much for your kind words.  I am very happy to hear some of what I wrote has been helpful for you.  Your psychiatrist sounds like a kind, well-trained doctor with a good pedigree.  However, most psychiatrists get no formal training in treating people with eating disorders.  The likely reasons your doctor is avoiding the topic or mentioning things like weight loss or various diets comes from a lack of knowledge more than anything else.  No, people don't just get better in treatment like this.  Even though your doctor is nice, I suggest looking for a therapist who has expertise in treating people with eating disorders.

 

Hi Dr _____,

Thank you so much for writing back and giving me your opinion- I greatly appreciate it. Originally I was just going to not make any further appointments with this therapist, but last week I ended up leaving very honest and tearful (ok, hysterical) voicemail for him, because honestly this was just bothering me so much. He responded with a lengthy voicemail in which he explained that he didn't really think I was fat or needed lipo; he had mentioned fad diets and liposuction as an attempt at "absurd rhetoric" which clearly wasn't effective. So the upshot is, I am going to talk to him at least once more, mainly because I am curious about what the heck he meant (some kind of reverse psychology?). **I know it would be best to find someone who specializes in treating eds (or at least acknowledges them), but unfortunately, that's easier said than done. Anyway, thank you again for responding to my question. And thank you for writing your blog; your insights are tremendously helpful- more so than anything else at this point!

 

HIS RESPONSE:

I do hope the appt with your doctor goes well. It does appear he had some thoughts about moving forward.  If you would like to, you could tell me where you live and I could see if I have any referrals there or ask colleagues if they do.