Ten things never to say to mentally ill people

One of the frustrating aspects of having a mental illness is dealing with stuff people say, even though they often mean well.  Here are just a few examples of things I suspect most mentally ill people are used to– and very tired of– hearing.

1) “But you seem so normal!”

Perhaps this is meant as a compliment, but honestly, it feels much more like an accusation– “you can’t really be sick.”  People with many forms of mental illness go through patterns of remission and relapse, so how you see us on any given day may be far from representative.  For example, I am currently euthymic (in a “normal” mood phase) but a month ago I was hearing voices from the heavens and believing I was a chosen conduit, and a week after that I was seeing rotting corpses hanging from my ceiling.  Not “normal”, right?  Also, many of us are great, sometimes to our own detriment, at putting on a happy, calm face around others, when we are being ripped apart inside.  And finally, sometimes this “normalcy” is the result of a treatment regimen that we have to work hard to settle on and stick to, which is not something “normal,” i.e. healthy-brained, people can really understand.  Don’t judge us by what you see; listen to what we have to say about our experience instead.

2) “Have you tried natural remedies?”

This is a tough one, because people who say this genuinely think they’re being helpful.  However, it’s important to remember that many psychiatric disorders are very difficult to medicate.  In the case of my illness, bipolar disorder, upwards of half of patients are classified as “treatment resistant.”  Many people spend years working with professionals to develop a successful treatment regimen of drugs and other therapies that are scientifically proven to work.  This can be a tenuous balancing act of avoiding side effects, toxicity and drug interactions.  In most cases, “natural” remedies are not only unproven but possibly unsafe, especially in combination with prescription drugs.  Keep in mind that whatever you have to suggest, we’ve probably heard of it before, and it can be deeply frustrating to be bombarded with well-meaning suggestions from people who are not experts in psychiatry.  Please, leave clinical treatment to the professionals.  If you want to be helpful, try instead asking what you can do to support the person.

3) “At least it’s not cancer!”

This is a deeply offensive and dismissive statement, even if it’s intended to make someone feel better.  Implying that psychiatric disorders are less serious or destructive than physical ones is not only unkind but flatly inaccurate.  Mental illness not only ruins but, all too frequently ends, people’s lives.  According to Stephen Fry’s outstanding documentary The Secret Life of the Manic Depressive, only 20% of people with bipolar ever become fully functional, while 50% will attempt suicide and nearly half of those will succeed.  Those are abysmal numbers for any illness.  Furthermore, we deal with many of the same difficulties that physically ill people do:  drug side effects, exhaustion, and physical pain, just to name a few.  Dismissing the severity of our problems makes us feel worse, not better.

4) “My ______ had that and here’s how they got better.”

I remember a specific conversation I had years ago in which a woman I barely knew told me in detail about her father’s undiagnosed mania and how he was able to “talk himself down” from it, and that therefore drugs and therapy aren’t really necessary, but actually inhibitive of self-help.  Another told me how fish oil had cured her brother’s depression; these are just a couple examples of the same basic conversation I feel like I’ve had a million times.  It’s problematic because no two mentally ill people, even those with the same diagnosis, are alike.  Our treatment needs to be based on scientific evidence obtained through clinical trials, not anecdotal evidence you’ve gathered from your limited frame of reference.  Assuming that our illness takes the same course as that of someone else you know (who may or may not have even had or needed the same diagnosis) keeps you from understanding what our experience really is and what we actually need.

5) “Everyone seems to have that nowadays!”

Short answer:  No.  They don’t.  You probably have that impression because of the way clinical diagnostic terms are bandied about inappropriately, for example, saying of someone emotional and moody “She’s so bipolar” or “borderline,” or of someone shy and awkward “He’s so Aspie.”  (Although autism is not actually a mental illness, this pertains.)  There are also many people who self-diagnose, to varying degrees of accuracy, often without understanding the reality of living with a severe disability.  While many disorders are more common than you might expect– in the case of bipolar, it affects about 1% of the population, so that if you have several hundred facebook friends, at least a few probably have it– they are not catch-all terms for every difficulty and behavior problem you perceive.

6) “Have you prayed/meditated/sought spiritual help about it?”

As an adamant, skeptical atheist, I particularly resent this one, but I would still resent it were I religious.  Frankly, my spiritual life, unless I choose to share it with you, is none of your damn business.  Carl Jung’s waxing on about the need for religion notwithstanding, there is absolutely no scientific evidence that prayer, meditation and other such practices can either treat or cure mental illness.  Some people may find comfort in spirituality, and that’s great, but it doesn’t take the place of medication and professional therapy, nor is it a necessary component of treatment.  My illness should never be a pretext for you to proselytize or cast moral judgment on me.

7) “Think about people worse off than you.  Lots of people would kill to be where you are.”

Again, this is deeply dismissive and hurtful.  It gives the impression that you clearly do not understand the depths of our pain and difficulty.  You are judging us by external factors like first-world citizenship, economic stability, and family support, which are all wonderful things but do not do away with or even necessarily diminish the anguish and dysfunction with which we live every day.  If you think my life is so great, I invite you to switch brains with me any day and see how you like it.  Hint:  You won’t.

8) “That’s a form of genius!”

Movies like The Aviator, about OCD sufferer Howard Hughes, and A Beautiful Mind, about schizophrenic John Nash, have contributed to this perception.  It’s true that people with many mental illnesses, such as bipolar and schizophrenia, can be highly creative, thinking in ways that a healthy brain rarely does.  However, such illnesses– and often the drugs that treat them– are equally likely to hold back mental function.  Some people with mental illness are very intelligent and creative.  So are some people with healthy brains.  And some are not.  Mental illness is, well, illness, nothing else.

9) “You’re really just an addict.”

Many, many people with mental illness, myself included, struggle with substance abuse as a form of self-medication.  And in many cases this does make matters worse.  However, it’s crucial to recognize that the substance abuse is a result, not a cause, of the underlying mental problem– a damaging coping mechanism to which we turn in absence of other effective treatment.  For more on this scientifically supported model of addiction, I highly recommend the book The Sober Truth, by Lance Dodes, and particularly chapter five, titled “So, What Does Work to Treat Addiction?”

10) “This famous person had/has that and was a great success, so you can be too!”

Recall again the numbers I stated above on the outcomes for people with bipolar disorder.  I am no expert on the numbers for any other disorder, but I do know that a few outstanding cases– again, like Howard Hughes and John Nash, and also like Stephen Fry, Richard Dreyfus and others– are far from representative.  There are a multitude of external and internal factors that determine whether someone with mental illness can create a fulfilling, successful life, and for many they are not advantageous.  Asserting this is no different from saying that because some people who drop out of school become rich and famous, anyone who drops out can be.  In some cases, such limitations prove not to be an obstacle to success, but in most, they do.  By positing illness as part and parcel of success rather than as a disability, you dismiss the pain and frustration most of us experience when we fail, so frequently, to measure up to the expectations of both society and ourselves.

In conclusion

It’s understandably hard not to feel like you’re walking on eggshells when talking to and about disabled people.  Everyone makes mistakes when trying sincerely to be helpful; that doesn’t make you a bad friend or human being.  However, a few simple things to keep in mind can reduce the chances of you saying insensitive, hurtful things like the ones I’ve listed.

Listen to us.  Don’t speak for us, and don’t assume.  You are not an expert on our experience, and your active listening and informed support is far more valuable than anything you could say.  Don’t dismiss us.  You don’t need to try to make us feel better about our situation; this feels patronizing, and furthermore, downplaying our suffering is insulting, not supportive.  And lastly, be ready to be corrected, and to apologize.  Don’t take umbrage if we say “that’s not accurate” or “that’s not helpful.”  We have the right to stick up for ourselves and to educate you about what you don’t understand.  In general, just let us guide the discussion.  Ask questions, pay attention to the answers, and don’t be full of yourself.  If you can do that, we will get along just fine.

What drinking feels like when you’re alcoholic

A year in to sobriety, albeit with several one-time relapses, I am still in the period of what’s called Post-Acute Withdrawal Syndrome.  The body can still have physiological cravings for alcohol even after this long, and mine does.  When these cravings pop up, tremors in my hands still appear and I feel an overwhelming sense of pressure, accompanied by the insidious certainty that a few drinks would make it all go away for a couple of hours.

It’s a subject I’m reluctant to talk about, because it makes the people around me fearful, which scares me.  Generally, it seems that despite all the platitudes about asking for support (about which I’ve written before) the recovering alcoholic, especially past the acute phase, is pretty much expected to go it alone and pretend that everything is fine.  The guilt of even having cravings, let alone relapsing, is enormous: a sickening, drowning sensation that increases the drive to drink; a sense of intimate personal failure.  Encouragement is hard to come by; judgment is not.  Understanding of and sympathy for the addict’s experience is rare.

I’m hoping that if I am able to describe what goes through my head on the sporadic occasion that I do relapse, I can reduce some of this stigma and help others to speak openly about their experiences.  I can only speak for myself, although my understanding is informed by, in rehab, hearing many stories from other addicts that tend to agree with my own conclusions.

Using a substance of choice is incomparably different for an addict than for a non-addict.  Through force of habit, psychologically and physiologically, a huge set of feelings and circumstances are intricately tied up with cravings and bad choices.  Certain stores are triggers.  Certain foods are triggers.  Some people are triggers.  So are some subjective experiences: fear, uncertainty, loneliness, despair.  Automatic thoughts are entwined in the addicts brain that obsess over alcohol, or another substance: terrible sirens who proffer sanctuary from a stormy inner and outer world.

Because of these entangled threads of craving, the act of relapse is a powerful one.  There is a moment when the sirens succeed, when a decision is made to drink, with the full but rationalized knowledge that the single end goal is to get so drunk that nothing matters.  It’s a precipice.  To find a way to turn back once you leap is rare.

There is the moment when you purchase the alcohol.  It’s like you can almost feel it in your veins already.  Your mouth waters, your stomach grumbles, you already wrinkle your face at the anticipated taste of cheap straight liquor pouring over your tongue (because that’s the quickest, least expensive way to get fucked up)– equal parts revolting and relieving.  All you can think about is getting somewhere where you can open the bottle and chug.

And then there’s that moment, the most important of all.  The liquor hits your lips, your tongue, your throat, your stomach.  It burns.  It feels like a necessary scourge, eating away what feels like necrotic tissue in the chest, cauterizing all the wounds.  It feels like pure power.  It’s done; no one can stop you.  It’s a bad choice, you still feel overwhelming guilt, but it’s your choice, it’s done, and even before it kicks in it is exhilarating beyond description.  Every craving you’ve had leading up to the act is justified by that moment.  It’s like taking off a mask.  It’s like coming home.  It’s like throwing in the towel.

It starts to work, just a few minutes after the first sip if your stomach is empty.  You feel it in your legs first.  The hot feeling from your stomach grows downward and starts to dissolve you.  Well-being drowns you, insistent, surrounding and withering the black thoughts that still lie beneath.  Every bad effect drugs have ever had on you is voided.  Nothing matters.  All you want is more, one more, one more, until you can’t anymore, until you’re passed out or puking or both.

The deep-seated shame increases exponentially, leaving you feeling like a little kid who pooped on the floor not once but a hundred times.  And what’s the solution to shame and self-loathing?  Another drink, of course.  More oblivion, please.

You can’t avoid knowing that you will crash and burn when the miracle drug wears off.  If you drink multiple days in a row, you will go through acute withdrawal again, which gets worse and more dangerous every time.  The pain will return, and so will the guilt.  After you pass out, you eventually wake up, in horror at the sober world and your sober self.

And sometimes you just want someone to forgive you, to tell you it will be okay.  But no one wants to hear your sin.  No one wants you to be less than they expect you to be.

Through a lens clearly

I have a list of therapies that haven’t worked for me.

This is not out of spite or stubbornness.  It’s because I’m starting to see a new therapist soon, and it’s important to me that they know what I’ve already tried and have not found helpful.  I don’t want them to rehash former attempts; I want them to offer me something new.

As a result, I’ve written a lot recently about therapeutic experiences I’ve had that missed the mark.  This is not meant to discount the experience of people who find a type of therapy helpful.  My assertion is always that patients are very diverse, and therapists need to be more cognizant of those differences to ensure they aren’t following a one size fits all policy.

There is a frequent misconception that if a specific therapy is not helpful to a person, it’s a consequence of the patient not understanding, not practicing what they learned, or not trying hard enough.  In some cases one or more of these may be true.  However, it’s also true that everyone has certain methods and styles that work for them, as illustrated by the fact that some therapies for the same symptom seem to be polar opposites in approach.

One example is the advice I’ve received about coping with obsessive thoughts.  One therapist and the books he gave me advocated acknowledging the thoughts and labeling them as obsessive and unhelpful, then seeking distraction through enjoyable activities.  The next therapist felt strongly that I should not label my thoughts, but should “sit with them” and accept them, and practice mindfulness and distress tolerance.

In my case, the former style has been far and away more successful in alleviating my discomfort and increasing my functionality, even though it doesn’t always work.  (Does anything?)  So I’ve adopted it into a set of coping skills that also includes healthy habits like yoga, studying astronomy, and writing, as well as not-so-healthy ones like smoking tobacco, comfort eating, and, formerly, drinking.  However, I’ve taken some flack from certain professionals who think that I am not doing a good enough job and am simply lazy for taking a road that includes playing video games and watching nerdy TV shows I’ve seen a million times (hello, TNG!) instead of meditation.  One therapy is judged more praiseworthy than another, not because it’s working but essentially because of its cultural cachet.

This perception of people as failing by rejecting a therapy results in a certain amount of shame and reluctance to speak up.  I’ve witnessed this in rehab, where one patient was going through the one-month program for the eleventh time, and a large percentage had been there at least once before.  How is it expected that following the exact same process, with all the same information and advice, will help someone who has already “failed” ten times?  At what point should we recognize that something simply isn’t working?

Twelve-step programs are another great example.  The first question most health care workers ask when you describe yourself as an alcoholic is “do you attend Alcoholics Anonymous?”  When the answer is no, there is frowning involved.  Twelve-stepping is the only therapy many therapists seem to accept for addiction, despite its flaws.

AA touts the idea that its approach is nearly always successful, and that if it doesn’t work for someone, it’s because they are constitutionally, pathologically incapable of honesty and responsibility.  In my opinion, this is a way of saying that if a person doesn’t achieve sobriety through their method, they are a lost cause because they are simply too flawed.  There is an assumption that if you don’t do AA, you don’t really want to sober up, and won’t ever succeed.

But in reality, the program is successful in only 5 to 10% of cases, akin to the success rate of any other specific type of therapy in addiction cases.  Even assuming that half the cases in which people don’t get sober through twelve-stepping are caused by internal or external factors in the patient’s life (which I consider a fairly generous concession) upwards of 45% of cases can best be explained by the simple need to find a different therapy.

Even in cases where the widespread effectiveness of a specific therapy is scientifically demonstrated, this does not constitute a reason to insist on one therapy and dismiss others in any given patient.  Naturally, if the success rate is 90% (based on a certain definition of success and method of research) then one in ten people is still not achieving optimal results.  Isn’t that a large enough percentage that it deserves a change in attitude; an increased willingness to shift gears and listen to patients about what works for them?

My favorite therapist I’ve had, who first raised the possibility of autism with me, used to say that it’s all about through what lens you approach a problem.  Two people’s respective symptoms may receive the same diagnosis, yet stem from totally different causes and require a different lens in order to clearly understand and effectively threat them.  He suggested that my autistic tendencies are likely so deeply rooted, being, of course, not a mental illness but a neurological difference, that failure to acknowledge them– particularly in treatment of my social anxiety– had probably caused a lot of my therapy to involve barking up the wrong tree.

After spending several months addressing autism issues and going over my symptoms to see if they were in accord with the diagnosis, the sheer relief I felt was like coming up for air.  I had a lexicon, for the first time, to describe my experience of life, and validation of the fact that I felt different but that the difference might not actually be a flaw.  I think the day I was tentatively diagnosed with autism began a whole new stage of my life and certainly of my mental health.

Not every experience I’ve had with therapy– as I’ve written about before– has been so positive.  If more professionals had questioned their own assumptions, listened more carefully to me, and done more research about potential therapies, it’s possible this stage could have begun much earlier, though that’s water under the bridge now.

Mental illness and developmental differences are often very isolating and alienating.  All patients deserve the relief of knowing that the first choice isn’t always the right one, and that there is no shame in speaking up for what you need.  Therapy is about the patient, not the therapist, and their well-being comes above preconceived value judgments and generalizations.

Why I stopped killing myself

There are many reasons I started drinking.  There’s only one reason why I stopped.

I remember the first time I got well and truly drunk.  I was 19, and I had bronchitis, as I tend to do several times per year.  I found that the only thing that soothed my cough and let me sleep at all was a bottle of wine that my mother in law (with whom I and my then-husband were living) had had in the fridge for some time.  I had sipped wine before, but never gotten more than a little buzz.  Without even realizing it, I ended up drinking the whole bottle of wine, and what I felt I had never felt before:  total relaxation, not caring anymore, feeling as if nothing mattered because a simple drink could make me forget it all.

Prior to that night, I had disdained alcohol.  I would go to parties at my parents’ friends’ houses and see people drinking and acting like fools, laughing too loud and talking too much, and I always thought “I never want to be like that,” so I would choose a glass of ice water over wine or beer.  In that moment, with that bottle of white zin, everything changed, even though I didn’t know it for a long time.  I started keeping a bottle of vodka in the fridge and making a Bloody Mary or The Vodka Still Works (= ginger ale + bitters + vodka) when I felt stressed out.  (To his specious credit, my then-husband would get upset with me and pour out my drinks, saying he “wouldn’t let me become an alcoholic,” although I think his motivations had much more to do with control than concern.)

But it wasn’t until a few years later that I really understood what alcohol could do for/to me.  I was divorced and had just gone back to university, and every time I was assigned a paper and tried to work on it, I froze up, panicked, couldn’t work, and the more I couldn’t work the more I hated myself and the more stressed I got.  So one night, convinced I was going to fail at anything I ever tried to do and never be loved or understood by anyone, I went to the store and bought a bottle of Merlot.  I drank the whole thing, and I lay on the floor puking into my wastebasket and I thought: “This is it.  This is the solution to every problem I’ve ever had.  If I could just feel like this all the time, everything would be okay.”  And being that I had drunk such small amounts before, I had virtually no hangover/withdrawal, so it seemed there was no downside.

Within the year after that, I began to have opportunities to socialize with people I’d met in class, which scared the fucking shit out of me.  It had been years since I’d had a “friend” or really spent time with anyone who wasn’t my abusive, possessive husband or partner.  Suddenly I understood that if I drank while I was with other people, I could stop feeling so petrified and actually talk to them. 

For the first time in my life, I went to parties, I chatted, I flirted.  I did the things I didn’t know how to do, and I didn’t realize until much later that I was actually being my usual bumbling, bizarre self only less toned down because I had no inhibitions while drunk.  I said whatever came into my head, which, it turns out, usually means I’m being a rude, insensitive asshole. 

I started making stupid irrational decisions, dating people with whom I had nothing in common and then suddenly declining their calls and dropping off the face of the earth.  I had unprotected casual sex even though I hated it, because it just didn’t seem to matter one way or the other.  I didn’t care about anything anymore.  I stopped planning my time and would rush off my assignments while shit-faced drunk at 3AM, knowing in my overconfident stupor that I’d get an A anyhow.  I burned a hole in my stomach that still flares up in times of stress.  I started to have constant tremors and sometimes hallucinations when I didn’t drink, and the obvious solution seemed to be to drink more, to drink all day every day, to just never be sober on the days when I wasn’t caring for my son.

Then I met Person of Interest, and for the first time somebody had a genuine, vested interest in asking me not to drink and abuse drugs.  I knew he loved me, though I didn’t understand it, and I knew why he wanted me to be sober.  But it wasn’t enough.  I would try very hard for weeks to not drink at all, because I was madly, head over heels in love with him and I wanted to do anything that would make him happy.  And then something stressful would happen and I would go on a total bender.  My mental health was beginning to decline drastically, and it was a terrible time for that to happen, while navigating a new relationship.

 Fast forward 9 months; I was hospitalized and then went into rehab.  I tried twelve-stepping.  I attended and I listened and I thought, and at first it seemed like magic, and then pretty quickly it seemed like pretense– just another religion I didn’t really believe in, with its bible and its catechisms and its rituals.  But there was a moment in rehab when everything changed, and it had nothing to do with AA or NA or abstinence or any of the rules or skills I was taught.  As often happens with me, my life changed because someone told me a story.

If you’ve read my Dysfunctional Fairytales, you will recognize this story as incorporated into the first, because it made such an impression on me.  During a meeting, a young woman stood up and recounted the story of how she watched her sister die of an overdose.  “She was a beautiful African-American woman,” she said with tears rolling down her cheeks, “and when I looked in her eyes, I could see that she would be dead, because they were grey, they were just grey.” 

And then she spoke of the children of her sister.  “I try to be close to them, but I can barely stand to be around them because the girl, she looks so much like her mom.  And the boy, he was two when she died, and I was taking care of them.  He’d wake up at night sweaty and screaming and crying ‘My mommy died.’  I miss her, she was my sister, but I hate her a little bit because of what she did to that little boy.”

I am a parent of a little boy, who was five when I heard the story.  And my heart broke.  I realized how selfish I had been, and that no matter how bad I felt, no matter how much agony, my son was worth any price.  As long as he was in this world, unless I abused him, which I would never do, it was better for him to know his mom– even if he ended up hating me– than to know that I killed myself, poisoned myself slowly, before he could even know me and decide.  I couldn’t– I can’t– bear the thought of him going through what that poor little two year old did, and I knew that I had a choice to spare him.  How could I choose any other way?

I’m not going to lie; I’ve gone on a few benders since that night.  I’m no angel.  I’ve relapsed, but it doesn’t last long, because with every drink I’ve taken since then that little boy’s face and voice, as I imagine them, have haunted me.  I may be many things but one thing I cannot do is harm a child, and to kill myself would be to irreparably harm the most beautiful child who has ever existed.  And to continue to drink day and night, to fool myself into treating it as a medication that I deserve, is no different from slitting my throat very slowly.  Any day, I could have gone into DTs and never recovered.  Any day, I could have been gone.  No matter how much it hurts, no more.  Never again.

Dear Food: I love you, I hate you.

Food, I’m calling you out, bitch.  I’m sick of your necessity for survival providing an excuse for you to endlessly frustrate and antagonize me.

There’s a cliche about how you can’t have anything good, fast, and cheap– you have to sacrifice one property to obtain the other two.  But you have to make it more complicated than that, of course.  With you, the difficulty is how to combine tasty, healthy, fast, and cheap.  And as a poor person without much time and energy to spare, who needs good nutrition to maintain my precarious mental and physical well-being, and who admittedly wouldn’t eat ramen or a peanut butter sandwich unless it was the last desperate option to prevent my imminent demise, and then possibly still not– I really need all four of those characteristics in you.

Then add on the fact that I’m strictly vegetarian, and trying to go (mostly) vegan.  Even when I sacrifice my taste buds’ fondness for the fatty scrumptiousness that is all forms of cheese, and face up to the extra time it takes to manufacture decent dairy substitutes, the kicker is the grocery receipt.  Cashews, faux milk, nutritional yeast and tofu, you guys are extortionate and I will say again, I am poor.  Oh, sure, tell me it’s my fault: things would be so much simpler if I lived on hot dogs, 60% lean chopped cow, and processed cheese-like product.  Well, some of us have a little self-respect and know what’s in those things and also don’t like feeling like a balloon with a brick in it.  Who are you to tell me I have to suffer through your sodium- and lipid-laden travesties for the sake of my bank account?

Oh, you say that then there are bulk dry goods full of non-animal protein and vitamins.  Of course I am not against the rice and lentils that my sweet Person so kindly boils up when the refrigerator’s empty or I am grumping about on the couch refusing to move.  But sometimes after a stupid long hard day I want some hot gooey strongly-seasoned comfort food, which brings us back to square one of having to either 1) pay a nice restaurant more than I can afford to make me something yummy and nutritious; 2) get something cheap but satisfying that I’ll later regret because it makes me feel like said balloon-with-brick-in; or 3) put in time and effort from my non-existent reserves to create something that fits the bill, literally and figuratively.  So what am I supposed to do, food?  Huh?

Sometimes I think the problem is really that I love you too much.  There is absolutely a codependency at play here.  If I was able to look coldly at you as a source of balanced nutrition, all would be solved.  Instead, I turn to you for comfort, entertainment and pleasure, even when I know it’s wrong.  You were there for me when I stopped drinking and then stopped smoking.  When I’m feeling miserable, I look to you for distraction, indulgence and solace.  When happy times arrive, you are my go-to prop for celebrating and, again, indulging.

In addition to the quadrangle of doom decried above, there is also the way you cling to me.  It’s so easy to take you in and so hard to convince you to leave.  Yes, I know that I am within a healthy weight range for my height, toward the low end in fact, and that the media is selling me on unrealistic, unhealthy and abnormal models of attractiveness and sexuality.  I know I’m supposed to learn to love myself as I am and accept that “this is how a woman is supposed to look,” and all that.  I wear a size 0 in pants, or sometimes kids’ sizes.  But it doesn’t matter, because when I look at myself, all I see is you all over me.  Short, stocky legs developing cellulite.  Soft bulgy belly.  Dangly flabby arms.

Almost every day, when I look at that evidence of our unhealthy trysts, I swear I’ll stop enabling you and put myself back in control.  I switched to skim.  I started drinking my tea unsweetened.  I swore off keeping chips and sweets at home.  But you always seem to find ways to come crawling back and get under my skin.  I’m worried you’ve been here for so long that we’re inseparable, and I don’t want to have to accept the way you weigh me down.  I want to feel skinny.  I want to not have to stare glumly down at my waist and thighs and berate myself every time we meet.  I want to not feel ashamed when I walk around in my underwear and am incessantly conscious of my flaws.  Why do you do this to me?  Why are you, like all the best substances, so addictive and yet so toxic?

Food, your silence irks me.  I am trying to place the blame on you here, but instead I end up talking to myself.