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Awareness Games: Breast Cancer and Domestic Violence

Every October, when Domestic Violence Month rolls around, before it even begins I get very, very tired. That’s because every October, gaining awareness for domestic violence seems to be an uphill battle against the pink army that is the other October cause, Breast Cancer Awareness Month.

That sounds really bitter, right? Like I hate people who support breast cancer or something? Wrong. Breast cancer is obviously a worthy cause that deserves attention. But does it have to steal all of the attention?

It is frustrating for those of us trying to gain support for Domestic Violence Awareness Month, trying to get our purple ribbons seen when we’re staring at an ocean of pink. An enormous part of the problem is stigma. A few decades ago, breast cancer was very stigmatized. Awareness campaigns brought out the subject and made it okay for people to talk about. Everyone understands now. Cancer is a disease; it’s not a person’s fault. The women who have it and are fighting it and living with it are considered brave, strong, even heroic. It’s a cause everyone can get behind without question; what kind of jerk doesn’t support cancer? People feel good about themselves when they buy a product that has a pink ribbon on it; it’s armchair philanthropy.

Listen, I’m not saying these things are bad. It’s amazing that the stigma on breast cancer has lifted, because millions of lives have been saved. It’s simply that, in comparison, domestic and sexual violence are still largely crimes that live in the dark. There’s a stigma attached to them that’s so severe, that one third of victims of domestic violence and two-thirds of sexual assault victims are not reporting to law enforcement. Of those victims, 41% of male and 34% of female stated victimization being a private/personal matter as reason for not reporting, 15% of women feared reprisal, 12% of all victims wished to protect the offender, and 6% of all victims believed police would do nothing.

Unfortunately, they are right about that.

Nationally, in the last 10 years the number of arrests for domestic violence have dropped from over 120,000 per year to around 85,000 per year. If a person in that one-third that comes forward to report a rape actually endures the re-traumatizing and invasive post-rape medical exam and is interviewed by police, it is highly unlikely that his or her efforts will result in justice, seeing as the conviction rate for sexual assault is only 3%— meaning  97% of rapists walk free.

How in the hell is that possible? It’s called rape culture. It’s just like how it used to be for breast cancer: unmentionable in public, the person who had it was marked somehow and there were sympathies to her face and gossip behind her back. In our culture, when a person is raped— especially a woman— she is the one with the burden of proof. She is considered a slut until proven virginal. We spend so much time focusing on what she was wearing, where she was walking, what she was drinking, and if she said no that we forget who the criminal actually is. It’s the same way with domestic violence. It is complicated and messy. There’s often substance abuse involved and children who are witnesses and fights that could go both ways. Emotional and verbal abuse are hard to pin down, though I assure you, it happens all the time. But come on: there is absolutely no fucking excuse for ignoring physical violence. And yet people do, constantly. No one wants to talk about domestic and sexual violence the way they are willing to openly discuss breast cancer. Why? Because it’s ugly; it’s painful; it’s shameful. People are afraid of it. And for reasons beyond my comprehension, people really love to blame the victims. While cancer patients are considered brave, victims of domestic and sexual violence are called stupid, lazy, slutty, and deserving of their abuse.

Every October, I feel burned out by the 2nd. I stare at the ocean of pink and wonder how in the world I’m going to gain attention for a cause that no one wants to speak or hear about. A cause that makes people uncomfortable, that triggers a flicker of shock across their faces as soon as the word “violence” comes out of my mouth. The only ones who are not shocked are the ones who have a personal connection to domestic violence. That’s when I hear the stories: “My sister had a boyfriend who hit her.” “I was married to a guy like that.” “My dad abused me as a kid.”

When I hear those stories, I have a bit of hope; these are people who will help spread the word. Perhaps they will understand, perhaps I can explain to them and make them realize how much we need to educate the public about domestic and sexual violence. I’m doing everything within my power. But when I look at all the major corporations and foundations that are sponsoring breast cancer, I think, I want those same resources for this. How do I make them realize that domestic and sexual violence are at an all-time high? 1 in 3 women worldwide will experience violence in her lifetime. How do I get them to hear that and maybe give their support towards another cause this October?

The thing is, breast cancer is no longer a crisis the way it was a decade ago. Female breast cancer incidence rates began decreasing in 2000, then dropping by about 7% from 2002 to 2003.  Death rates from breast cancer have been declining since about 1990, with larger decreases in women younger than 50. These decreases are believed to be the result of earlier detection through screening and increased awareness, as well as improved treatment. Think about it; that pink ribbon has become synonymous with breast cancer, and you can find it on every product imaginable. The Susan G. Komen Foundation in particular has done an incredible job with this. Another big part of the decrease is due to the fact that pharmaceutical companies and companies that sell medical and surgical equipment will invest in awareness campaigns, the pink ribbon branding, and fund-raising for research, which brings in millions of dollars every year for the cause. Domestic violence does not have this resource because so far, there’s no surgery that can prevent a man from beating his wife, and chemotherapy can’t cure incest. Those companies have no interest in sponsoring a cause that will give them nothing back. With breast cancer, there are patients that use their products so they recoup that money. Until we figure out what part of the brain makes a person violent toward their loved ones, or find a medicine that can erase the effects of sexual trauma, those companies have no incentive to spread purple ribbons the way they do pink, or try to raise funds for victims’ services. Meanwhile, the statistics show a 42-percent increase in reported domestic violence and a 25-percent increase in the reported incidence of rape and sexual assault. Does this mean that I think we should ignore breast cancer? That breast cancer is no longer a problem and we should focus solely on domestic violence? Of course not. Breast cancer is still a killer, the second deadliest cancer after lung cancer, and obviously, we need to keep seeking a cure. But do I think it’s currently at the crisis level that domestic violence is?

No.

Saying that is going to upset people, possibly offend people, particularly those who have loves ones affected by breast cancer. I understand your feeling that way. But when you take a look at these numbers, you might begin to understand where I’m coming from when I say that.

–       About 1 in 8 U.S. women (just under 12%) will develop invasive breast cancer over the course of her lifetime.

–       Twice as many, 1 in 4 U.S. women (25%) has experienced domestic violence in her lifetime.

–       In 2011, an estimated 230,480 new cases of invasive breast cancer were expected to be diagnosed in women in the U.S., along with 57,650 new cases of non-invasive (in situ) breast cancer (288,130 cases total).

–       Twenty times as many, an estimated 6 million women are victims of domestic violence each year

–       On average, more than three women and one man are murdered by their intimate partners in this country every day. Intimate partner homicides accounted for 30% of the murders of women and 5% percent of the murders of men. Homicide is the number 1 cause of death in pregnant women. Most intimate partner homicides occur between spouses, though boyfriends/girlfriends have committed about the same number of homicides in recent years.

–       One in five (21%) women in the U.S. reports she has been raped or physically or sexually assaulted in her lifetime. Three in four women (76%) who reported they had been raped and/or physically assaulted since age 18 said that an intimate partner (current or former husband, cohabiting partner, or date) committed the assault.

–       Nearly three out of four (74%) of Americans personally know someone who is or has been a victim of domestic violence. 30% of Americans say they know a woman who has been physically abused by her husband or boyfriend in the past year.

–       There are only 1,500 shelters for battered women in the United States; there are 5,000 animal shelters.

This is beyond unacceptable. When we have more resources for stray animals than

abuse victims, something is seriously fucked up.

This whole thing may sound like I’m trying to make the month of October some giant competition between breast cancer and domestic violence, like I think one cause is better than the other. That’s not the case. What I really want is just some more air time, a little more space, and more financial resources to do as wonderful a job of eradicating the stigma around domestic and sexual violence as the breast cancer camp has done. Seriously, we need some of the breast cancer publicists over in the domestic violence camp! Those people get shit done.

Another suggestion that has been made is to move Domestic Violence Awareness Month to May, so it won’t be drowned out. That could work. As long as there is some time dedicated to fighting for this cause. As many of you know— if you’ve read any other part of WfR— I’ve got my own (long and intense) history with both domestic and sexual violence. Whenever someone takes up a cause, it’s not a coincidence; they do it because it affects them somehow. That’s why this is such an emotional topic, and why, when I bring it up, people who are affected by breast cancer tend to get pissed off at me. That’s okay. As long as it’s being discussed, as long as it’s out in the open, perhaps things will begin to change.

© Sarah Ann Henderson 2012

P.S.— In the interest of fairness I feel I must add that there are two other October causes that get even less attention that either breast cancer or domestic violence: Pregnancy and Infant Loss Awareness Month and National Bullying Prevention Month. Both of these are really important and deserve attention too, please take a look at their websites for more information!

National Bullying Prevention Center

Remembering Our Babies

FirstCandle.org

Statistical Resources Included:

Bureau of Justice Statistics

Domestic Violence Resource Center

BreastCancer.org

Susan G. Komen Foundation

Human Rights Watch

ASPCA

Clark County Prosecutor, Domestic Violence Office

Centers for Disease Control

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National Recovery Month Stories: Jim

Hello everyone! Welcome back to the National Recovery Month Story project here on Writing for Recovery. Thank you for joining me once again as I introduce another account from someone who works on the front lines battling addiction. Jim is the executive director of a counseling center specializing in addiction, dual diagnosis, and trauma. Every day he works to bring people to a deeper understanding of themselves in order to help them find their way to a meaningful recovery. He has a wonderful perspective on what it takes to walk that path- and how patients and counselors can work together to accomplish lasting recovery. 

 

My name is Jim and I’m a recovery ally. People in recovery from drug and alcohol abuse don’t expect me to be able to understand them. I don’t blame them one bit. I’ve never been an alcoholic and my drug addictions are limited to caffeine and nicotine. These are not exactly conditions that make a person’s life unmanageable, at least not in any short order. Worse, I am seen as less likely to understand because I am a professional in the addictions field. My friends in recovery have too often received poor quality of services, judgment, and been generally shamed by people in my line of work. This must stop. Being a recovery ally means that I seek to be part of the solution to all of the problems associated with the disease of addiction.

In general, if a person hasn’t walked a mile in your shoes it’s hard to believe that they can really understand what it’s like to live with what you live with. I have found that most folks who haven’t been an addict or at least been very close to an addict can’t begin to wrap their mind around what it’s like to be one. I know that while I cannot relate to a person whose experiences I have not shared; I can understand to the best of my ability what it’s like for them and support them in overcoming their disease. All that this requires is that I get my ego out of the way. I listen and listen well. I ask dumb questions and I show a genuine interest in what it’s like for them. The addicts and alcoholics I know tell me that they find this unusual and refreshing.

I love working with people in recovery because I like people who are exceptionally genuine, motivated, and who seek to make great changes in their lives. Normal people bore me. Normal people do not generally make life altering changes. They do not often become something far greater than they are. People in recovery inspire me. I love their candor, their accountability, their integrity, their humor, and their willingness to go to any length to become happy, joyous, and free. I am blessed because people who are willing to make this kind of commitment seek me out.

The recovery communities of 12 step programs are vastly more effective than any professional intervention or organization will ever be. I see what I do as merely a compliment to the work of AA, NA, Al-Anon and others. I am one person working in one organization. Self help programs total tens of millions of people all over the world who genuinely care about their fellow members. Being a recovery ally means having the humility to know that what I do may be important, but it will never be a fraction as important as membership in a self help program.

Never have I been so welcomed by any group of people as when I have attended AA meetings. My colleagues do not receive me one tenth as well. Even after I explain that I am not an alcoholic, I am frequently thanked for attending, for showing an interest, for offering support, and for showing respect to a program that works exceptionally well. Amazingly these folks do not hesitate to share their experience, strength, and hope with me. They speak the most intimate and painful details of their lives in front of me, knowing that all attending have the opportunity to connect, learn, heal, identify, and grow based on these experiences.

I came to work with people in recovery through a backdoor of sorts. I started out as a mental health therapist and found that many of the people I was serving also had problems because of drugs and alcohol. I quickly came to understand that as long as they continued to abuse drugs and alcohol, anything in mental health would be of limited value to them. In most cases I find the importance of being clean and sober as being foundational and of far greater importance than issues of mental health. Today I understand that depression and anxiety are normative experiences for a person who is active in addiction or who is in the early years of recovery.

Being a recovery ally means that I am an educator. I share what I know and I defer to those who know more than I. I am far more likely to refer my clients to people in local recovery than I am to refer them to professionals. I am able to do this because I know people in the local recovery communities. Being an educator also means that I acknowledge that as a society we are not effectively educating children, adolescents, and adults of the dangers of addiction.

The best recovery allies are advocates. We know that current systems fail to meet the needs of people in recovery. Punitive approaches to alcohol and drug abuse have consistently failed to deter or reduce recidivism rates. We need to bring attention to what works (self help, rehabilitation, abstinence) and challenge prevailing stereotypes (addicts and alcoholics as bad people, criminals, or only belonging to poor and working class). We need to demystify recovery (it’s not about religion, it’s not people sitting around just talking about their problems) through achieving direct knowledge of recovery. It’s not enough to encourage people to join self help. Having direct knowledge of local recovery means that we can share our experiences to motivate others.

The hardest part of becoming a recovery ally is learning not to enable. Those who do not understand alcoholism or drug addiction are often unwittingly helping their loved ones to stay mired in addiction. Enabling almost always feels like the right thing to do. It’s something we feel compelled to do. Not protecting our loved ones from harm is counter-intuitive. We had to learn that protecting those who abuse substances from the natural consequences of their actions is to do them a disservice. We learned that in general people stop using because they get sick and tired of being sick and tired. Suffering is a powerful motivator.

Finally, the most important part of being a recovery ally is the willingness to collaborate. The AA tradition of “principles over personalities” strikes at the heart of our lack of collaboration. We need all stakeholders to come together if we are to make a substantive impact on the disease of addiction. Too many of us as Adult Children of Alcoholics are afraid or disinclined to share what we know and what we’re doing. Agencies and groups often behave like alcoholic families. We compete with one another from the mistaken belief that there is not enough to go around. Sharing our knowledge of what works and combining our efforts will yield far greater results than we have ever seen.

Jim LaPierre, MSW, LCSW, CCS

Higher Ground Counseling Services


The Weight of Her Words: “Crazy Weights (A Game)”

This poem sort of mirrors the manic feel of being caught up in a serious eating disorder, as well as how suddenly things can go wrong.

 

5/3/08

 

Crazy Weights (A Game)

 

Put it on, take it off– the objective: To win

You drop and you rise, then play again

 

When the weight is put on by some hospital staff

And the choice is being made on your behalf

 

It’s agony, torture, you just wait to break out

Through the whole thing you shriek and you pout

 

As soon as you’re gone there’s nothing to lose

Except for the fat that they have infused

 

Time to step up– new here are the rules:

You must cut your food into molecules

 

You must check the scale at least every hour

With every pound lost you will have more power

 

Throw up every calorie over the line

Know where your boundaries are, keep them defined

 

Run, lift, and stretch, come on, keep it up!

Remember the goal here, you’d best not fuck up!

 

But oh no, it’s beginning to complicated

The stakes are becoming elevated

 

Your body’s rebelling and you’re getting sick

You’re starting to hear the game’s timer tick

 

But if you’re going to die, by God, you’ll be thin

Come on now, come on, there’s still time to win

 

Keep working, keep running, they can’t make you stop

They’ll try but they know you’ll run ‘till you drop

 

But in the end when your body gave out

And your family was left to deal with the doubt

 

Could they have done better? Could they have done more?

Were there symptoms or signs they might have ignored?

 

If you were alive then you might feel regret

You might want to say sorry for all the upset

 

But now you will never receive that chance

Because you decided to dance this mad dance

 

In the end was trying to “win” worth the cost?

For it wasn’t just you– everyone lost

 

 

© Sarah Henderson 2008


Comorbid: Inside the mind of a Bulimic Anorexic

Bulimia is a world that is difficult to explain to the uninitiated. It is particularly difficult to explain to anorexics who have never crossed that threshold to the other side of eating disorders, the side that cannot resist, loses all ability to keep from doing the very thing anorexics fear most: Needing.

There is a strange dualism in bulimia, one that is symbolic on many levels: There is hungry/full. Then full/empty. Bad/good. Weak/strong. Chaos/control. Vulnerable/powerful. Low/high. Needing/not needing. It is a physical manifestation of all of these things, and a strangle knot of dilemmas. You need both but only want one, and it doesn’t work like that and that pisses you off. At the same time, the vacillating back and forth serves so many psychic purposes that it is very well defended. It is highly structured and highly ritualized, which makes it feel reassuring, something to anchor your day with. There are usually certain foods that are binged on, a certain time and place and pattern to it; the planning of the act is as much a part of the ritual as the execution.  There is money that is set aside for it like any other drug– and, like any other drug, the need for it takes precedence over all else. That fact is one that you use to beat yourself up with, which just causes you to need it more.

Shame is perhaps the most accurate word to describe the feeling that comes with bulimia but it is far from being sufficient. There is a myriad of other feelings that come along with that. In particular, when someone stumbles upon you in the middle of your ritual. There is shock. Horror. Panic. A blizkrieg of guilt. Embarrassment and shame do not even begin to cover it. There is also a wish to die that far outstrips the desire for the massive amount of food you were just caught eating. And whether you flee from the situation or commit suicide right there, you cannot stand the thought of being any longer in the presence of this person who has seen you for what you truly are: A weak, needy, selfish, fat pig who deserves the slow and painful death that comes from starvation and repetitive vomiting. If the person that caught you is someone who you have to see on a regular basis, (e.g., a roommate) you will probably avoid them for days, if possible. You do not talk about your nightly forays into the hell they call bulimia. If you are anorexic as well, you will be extra careful. Because the judgmental voice that commands the silence will be even harsher. You’ll talk about your ability to starve at length but you will never tell anyone, least of all other anorexics (who you are positive will look down on you), that at night you lose your ability to stay in control and find yourself drowning in the food you spent all day avoiding. The only thing that redeems you is your ability to throw it back, to get it out, to flush away your sin. That ability brings you back into the place of being able to say with some authority what goes in your body– and what stays out.

There is also a physical high that comes with purging that is somewhat similar to the one that is caused by starvation, only it is fast and powerful instead of slower and more diffuse. Think of how a shot of tequila effects you as opposed to a margarita over a couple of hours. When you throw up you are standing and leaning over. And when you straighten, the postural change gives you a fairly potent head rush, as does the electrolyte imbalance and the dopamine flood that soon follows. After it is all over you will be calmer, no longer hungry but no longer full. It feels as if you have flushed away the stress of the day. You will have the reassuring feeling that comes with knowing that your stomach is absolutely empty. Your pills will work better, you will not be anxious or fidgety or obsessed with eating. You will be able to think clearly and focus on other things.

Until the urge strikes again.

© Sarah Henderson 2006


“FAT is Not A Four Letter Word” by Ramona Carmelly

This is an excellent guest post by my friend Ramona. Love her argument!

FAT is not a four letter word.

I applaud anyone’s determination to manage their health and well-being, physical and emotional.  With parents, society, and now schools becoming the fat police, this (paradoxically, counter-productively, ironically) creates an environment in which eating disorders and body dysmorphia thrive.

As someone who has spent all of her adult life on the other end of the scale (pardon the pun), this makes me see red! When I was 13, I was 5’2 and I weighed 137 lbs – my petite mother panicked and dragged me to the doctor, beginning a life-long cycle of diets and weight gain, strict regimented eating or binging, and continual self-denigration. As a result, I have “yoyo”ed between sizes 18-24 for my entire adolescent and adult life. It has taken me 32 years from that day to overcome the damage to my spirit and I am just starting to overcome the damage to my body.

Enough! We have to combat the zeitgeist of fat phobia – the last widely permissible (even lauded) bigotry. The very word, “fat”, has become overloaded with anxiety and negative values. It has taken on hugely disproportional connotations of shame and mortification, and no longer functions as noun or adjective, but rather is used almost as a swear word. With the onslaught of media messages, from reality shows and “helpful” talk shows, the fashion industry to news reports of the latest “studies” on obesity, it is very easy to be caught up in the social frenzy and buy into the myths of fat vilification. Women in particular are bombarded with the message that if we are fat, then we are (or should be) physical, emotional and/or spiritual cripples, and fair game for all sorts of derogatory comments.

I refuse to participate in or perpetuate that mythology. We owe it to ourselves and our sisters and daughters, and yes, also our brothers and sons, to combat the tyranny of our fat phobic society and how it targets and denigrates people based on size. You are beautiful at any size.

Let’s be clear. We do not have a weight problem. We have a weight. They have a problem. Let’s stop letting them dump their problem on us.

In my adulthood I rediscovered my joy of dancing and movement as well the pure unadulterated elation that comes from celebrating your strength, flexibility and endurance. I’ve walked 60-kms in two days (raising $13,500 to combat cancer) and had the blisters and lost toe-nails and sunburns and a cold from walking all day in the rain (because while healthy activity supports the immune system, extreme activity has been shown to suppress it) to prove it.  I’ve biked all around this fantastic hilly city of mine (just take a look at a topographical map of Toronto and you’ll see what that entails). I took Yoga and  Pilates classes, found myself able to contort my body into fantastic shapes and positions, though humorously hindered by bumping up against bits of myself in the process (like the time I had my legs thrown way back behind my head and found myself with a face-full of my own bountiful bosom, unable to breathe). And, after laughing at the strength-training instructor who wanted me to do push ups (Sure, honey. Tell you what. If you can bench press ME, we are on. Otherwise, can I push YOU up?), I discovered that real weight training was a true exercise in both torture and pleasure. Who knew it could be so satisfying to bench-press or leg press or, even, those dreaded PUSH-UPS!

All that physicality finally taught me to love my body as it is.

Full disclosure: I currently wear about a size 24 (well, the labels say everything from 14-26, but i know my measurements so let’s call it that). In the last couple of years I’ve discovered something has shifted in my marriage. My husband, who used to be enthralled by the more usual womanly erogenous zones, is finding my voluptuous belly irresistible! His hands will inevitable stray to and linger on my belly. This paralleled my own (gradual and hard-won) acceptance of that part of my body.

Our unjustly maligned and oft-reviled yet generous and forgiving bellies can be honoured as a source of sensual pleasure, as well as serving so well in all the ways mentioned by Sarah Henderson in her wonderful poem, My Belly: A Poem of Love and Hope.  I just LOVE this. It’s posted in the Poetry section here on Writing for Recovery.

You know, it’s a funny thing I realized on the way to size acceptance. No matter what size we are and whether it’s our ribs or our rolls that are more evident, even swathed in a burqa, our bodies make their unique and wonderful shapes known. It’s not like we really can hide the truth of our body, so why not embrace it instead?

© Ramona Carmelly 2010


Thin It to Win It: Competition in Treatment

When you have an eating disorder (particularly anorexia), people react in one of two ways. Either they want to get you help– or they’re jealous. Obviously, the latter group has some issues of its own. We still, however, take in those reactions. It’s everything from, “Wow, I wish I had that much self-control,” to “My goodness you’re so tiny!” or worse, “Tell me how you do it.” The most damaging part of these comments? They don’t stop at the threshold to treatment.

Whether you attend group therapy, intensive outpatient, or especially inpatient/residential treatment, the competition and the comments still happen. We like to believe (as do our loved ones) that negative body-talk ends when you show up for therapy. Unfortunately, this is usually not the case.

What I really want to focus on is how this takes place in residential treatment settings. From my own experiences and those of others, it seems that there’s a much higher incidence of this sort of competition and negativity on adolescent units than adults’. I think this has a lot to do with the fact that the vast majority of adolescent girls in eating disorder treatment are not there voluntarily. There were put there by parents and doctors and therapists who are, according to them, taking away the only thing that they have any say over, the only thing that belongs to them. So many of these girls stage underground mutinies, banding together in subversion of the system, helping each other dodge rules and restrictions and staff. And while this creates a great deal of comradery, it has the unfortunate effect of keeping everyone sick. Because on the other side of the wall are a bunch of very sad, frightened little girls, consumed by shame, self-hatred, and guilt. And at the same time that they are acting like a team they are also competing to be the thinnest, the sickest, the best at this disease.

I don’t think this gets talked about enough. We often hear about pro-anorexia web sites and models who got airbrushed on magazine covers; what we don’t often think of is the influence other patients have on us in treatment. The first few times I went to group therapy and IOP the only thing I got out of it was an array of new eating disorder tricks. I constantly compared my body to the others in the group (even the therapists!) and never stopped obsessing about whether or not they were judging me for not being thin enough or sick enough to “deserve” treatment. During my first experience in an RTC, my two roommates and I developed a late night calisthenics routine that we did after lights out, trying to see who could go the longest before their meds kicked in. One of those roommates asked me to teach her how to throw up. (That, I refused to do, knowing it would only open the door to a whole new kind of hell she would eventually have to escape from. If she got there on her own, whatever. But I was not going to be responsible for helping someone go there.) Needless to say, recovery did not even get a foothold there. It was like this in all the adolescent units I visited. Every now and then one of us would get a grip and go, “Come on, guys, I’m really trying to eat here,” or “Maybe you should listen to your therapist,” and everyone would feel kind of guilty and it would quiet down…for a little while. Then people would start to get anxious again and it would go right back to the way it was: everyone outwardly cooperating, while secretly judging each other and themselves for not being good enough.

Things work a little differently in adult RTCs. And again, I believe the major factor is whether or not you’re there on a voluntary basis. There also seems to a connection between programs that are located in medical hospitals as opposed to those that are located in houses, etc.; in my experience there is more noncompliance and competition and negativity in hospital environments than in others. (Note: This is just my experience and may be a gross generalization.) Whatever the program’s location, from what I’ve seen the same sort of things that happen on adolescent units still happen on adults’, just much less. People in adult programs are mostly there because they’re sick and they know it and it was either go to treatment or die and they didn’t want to die so they went to treatment. Most of these people are still ambivalent about recovery. There are others who are totally ready for it, and still others who just felt forced to come and don’t care at all. This can create some interesting group dynamics that are much more complex than those of the adolescents’ milieu. Mostly I think the competition and judging is reduced to everyone’s’ heads and journals and individual therapists; we are still constantly over analyzing, judging, and worrying about being judged. We are still wanting to be the thinnest, we still compare bodies; we just don’t do it as openly anymore. We are more aware of the fact that some people REALLY ARE trying to recover. A lot of that is because we are no longer teenagers, who are genetically programmed to be egocentric. Still, we are all worried we are not sick enough, not good enough, not enough period.

What lies beneath this competition is more than just insecurity. That feeling, that fear of not being sick enough, is not about vanity or rivalry; it’s about feeling so worthless that you don’t believe you deserve to be cared for. That’s what it comes down to. We don’t believe that we deserve help, deserve rest, deserve to ask for what we need. In other words, we don’t believe that we get to be human. And when we compete with each other to be the thinnest, the sickest, what we’re really doing is trying to prove that we’re worthy to be in treatment; worthy of the time and energy of the staff; worthy to nourish our bodies, worthy to start to heal. There are some places that address the issue of competition among peers and that is to be commended. I wish more of that would happen. Because the more it is brought out into the open, the more we can focus our energy on fighting our eating disorders– instead of each other.

© Sarah Henderson 2010