Time for the Shrink

I recently made a new friend I’ll call JH who said she was ready to see her doctor but she kept chickening out. She asked me for my advice on what to say to the doctor; here’s what I had to say.

First stop – psychologist, not a medical doctor.

Now don’t freak out over this thought and start worrying about what everyone will think about you visiting a shrink (who really gives a rip about this at this point since your life is in total shambles, plus screw ‘em, if they want to judge you so be it) The basis of your eating disorder is the way you think and the sooner you own up to this the better (and just an FYI in case you don’t know a Psychologist can not prescribe medicine, he/she would have you see a Psychiatrist for those needs).

Update 10/7/10 Reminder: mamaV is not a professional, nor do I claim to be.

I am not stating an ED sufferer should not go to a medical doctor.  It is my opinion that a psychologist is an appropriate first step, with the next step being a medical doctor.  The truth is that many of us end up in the ER or in a medical doctor’s office due to our physical condition, so in many cases the sufferer does not have a choice. However, when faced with a choice, I believe many medical doctors do more harm than good if they are not trained in eating disorders, leaving sufferers with questions about their illness & diagnosis. I can’t tell you how many times I have heard from individuals who are told to simply go home and start eating. Wow. Now that is great professional advice.

Would I go so far to say that eating disorders are 100% mental illness?


Absolutely. Medical issues are the side effect of our mental condition, and yes, at some point they should be evaluated by a medical doctor, but I would not recommend it as your first stop (unless of course you pass out in school from dehydration, keel over with a heart attack when exercising, or succumb to any other of the lovely ways girls tend to go down with this beastly condition).

Oh, that’s right. That will never happen to YOU right?

Heard it tons of times girls, don’t kid yourself for a minute that your body is somehow strong enough to take your punishment. I thought this too when I was a teen and 20 something, and now I realize what an incredible, stupid risk I was taking with myself. I thank God nothing happened to me, and that I didn’t do any permanent damage to my body that I am aware of, except for a herniated disc in my back from over exercise. But I remember when I was ready to have kids, I was scared to death I wouldn’t be able to since I didn’t get my period for such a long time. I know TMI.

So get your butt into the shrink and figure out what the heck is going on with you, I’ve got an entire section of the site that provides resources.

Oh…you don’t want to have a mental illness? You worry about the stigma of medication? Tell me about it.

To this day, I get a twinge in my stomach picking up my prescriptions at the pharmacy since I just know the guy is sweet as pie while he is silently eyeing me and the kids up in our mini-van thinking “another doped up housewife popping pills” (I am no housewife, nor am I doped up, but yes – I have to pop quite a few pills to get through the day).

Do I wish it was different?

Do I sometimes wish I could hack it without the drugs?

Truth be told, not really.

Because I’ll tell ya what. Life before drugs SUCKED. And I mean sucked big time. I am never, ever going back there, back to that spinning head, I am a lifer, period.

Back to you and the point of the post, I do think there is a point in here somewhere, oh yeah, here it is in a nutshell;

IF YOU THINK YOU HAVE AN EATING DISORDER, YOU HAVE ONE.

There’s no criteria to meet, there is no weight you need to get to, that’s all just a ball of crap. It’s about what is going on your head, you and I both know that, and a good psychologist is going to get that and he/she will help you get your life back.

Love,

mV

XOXO

Image source: Yeah, its fine’s photostream

About mamaV

Former Paris model providing advice for eating disorder sufferers who aspire to be thin, follow the proana lifestyle, and lack self esteem.
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26 Responses to Time for the Shrink

  1. Shannon says:

    PERFECT post…and it couldn’t have come on a BETTER day!!!!
    I swear you ALWAYS have the right words for the right moment.
    Thank you for ALL you do…you are for sure helping to make this world a better place.

  2. mabel says:

    I’ve been seeing a psychiatrist for 5 months already.At first she got kinda upset because she told me I wasnot putting effort to heal and just lying to her.I’m taking my meds everyday for depression and my mood is different,significantly.I’m still struggling with food and self harm.I just wish I were different…Not this huge and disgusting..I guess it’s too much to ask,almost a dream..

  3. .C. says:

    Sweet post, MV. Incidentally, I gave blood today, and not only did I NOT pass out (as I always did back in the ED days) but I was done in 12 minutes instead of near 40, my blood pressure and heartbeat were great and regular, and my iron was awesome high (16.7!). I’m healthy, and I’m proud of it.

    .C.

  4. Shelly says:

    I disagree with not going to a doctor first. A doctor should be one of the first stops. First, a person shouldn’t wait until they pass out, etc. Often, many people don’t even realize their labs are off. Plus, refeeding and nourishment is ESSENTIAL for therapy. When a person is malnourished, lots of times therapy is ineffective. A doctor is Essential to rule out any problems associated with an ED. I think it is dangerous to tell people to wait to se a doctor. Just my opinion.

  5. NTG says:

    I disagree big time. Anyone seeking help for an ED should visit their doctor first. There are electrolyte deficiencies, vitamin deficiencies, and a whole of things that should be addressed prior to seeing a shrink. One wants to have a good idea of where their internal body is before getting slammed with anti depressants or any other type drugs which normally are prescribed with a shrink.

    Going from personal experience, had I seen the shrink first before seeing my doctor it would have killed me (i.e. heart attack). Always seek you doctor first. Body, mind, soul is the way to go.

  6. Ella says:

    I understand you’re trying to explain that it’s a psychological illness – but it’s a psychological illness with physical side effects that has the highest mortality rate of any mental illness. Suggesting that people not go and see a medical doctor initially is negligence. As well as that – rarely will psychologists see a patient without a diagnosis or referral AND that must come from either a medical doctor or a psychiatrist (at least here in Australia it must).

    But please, please, please don’t encourage people to not see a doctor first. Pathology results can indicate a host of abnormalities that have NO symptoms. Even hypokalemia (low potassium) can cause cardiac arrest and the sufferer might not have any idea. It is SO important to get medical help. I also, as both a patient and almost a nurse, don’t believe that people should go treatment alone – or without a medical team. That includes psychologist, psychiatrist, GP and nutritionist.

  7. anonymous says:

    I have to agree with the last few comments. It is reckless and dangerous advice to tell people not to see a medical Dr. before going to a psychistrist or psychologist. Sorry- but it’s how I feel and as another person said, many shrinks won’t see a Ed patient without a medical examination first because they want to make sure that they are compotent enough to be treating the patient. Mine didn’t. Many shrinks want to make sure that the patient is stable enough medically to be in psycotherapy so they don’t get sued. Once the evaluation has taken place, then it is vital for a nutritionist, MD and appropriate mental helath care professional to work together as team. But to tell someone not to go to an MD when their medical health could be in jeporday and they might not know it and see a shrink instead first is irresponsible. Psychtriasts even while MD’s and certainly psychologists do not have the specific knowledge that regular MD’s do when it comes to all the lab stuff they test for like thyroids, electrolites, B-12 deficienies etc. I think you crossed a fine line here by making that suggestion.

    • anonymous says:

      Another suggestion- and I don’t know where this girl is from or what resources she has, but many out patient eating disorder clinics offer both a physical with full lab work and also therapists in the same place. I know Renfrew’s OP clinic does and many others like Columbia. It might not be a bad idea for her to see what’s in her area.

  8. Franziska says:

    I know this is off topic a little, but the psychiatrist I’ve been seeing for three and a half years just “dumped” me. I have to see a cardiologist (again) because I have congestive heart failure now. I hadn’t even been to my primary doc in over a year out of fear of stuff like that happening. I don’t even digest food properly anymore. I would have to say I should have been getting physical care outpatient from the doctor long before now (not just in a treatment center I’m occasionally in and out of). I do agree that a shrink needs to be one of the first stops, just in my case, I should have been seeing my doctor also at the same time. I don’t really remember my point, I’m just scared right now because I don’t know how much longer I can hold on, especially since now I don’t even have my psychiatrist.

  9. gabi says:

    I agree with the aboves saying that it is negligent to say not to go see a medical doctor first. Although I dont know how it works in the USA if your in the UK and you want to see a psychiatrist or psychologist you have to see a medical dr first and be referred and then most likely cos the NHS is shit be put on a waiting list which takes forever. But unless your paying cash for private you still a medical dr for your referral letter to see the private shrinks as well if your insurance pays (in whihc case you see within a few days).

    In my case though, I went to my dr and she ran no tests as i didnt “look” unwell and was put on a waiting list to see the ED team. When the letter came through I was told once id seen them id be put on another waiting list. I then had a heart attack. My dr already knew id been in treatment once for my ed so this ws during my relapse and my nutritionist was writing to her begging her to have me sectioned. My parents placed be back in treatment in South Africa where the psychatrist there ordered my treatment team to send me straight into hospital cos my bloods were so bad, i was on the verge of another heart attack and i needed to have a camera down my throat which revealed uclers and tears. 1 month later i was still so ill i went back to hospital where it revealed i had internal bleeding an my iron plummted to 1.0 i had 7 tranfusions to bring it barely into the normal range. Im on meds for the rest of my life and on psych meds ill someday come off. My iron is fucked as is my potassium.

    Now my dr never ignores me. When i got home i was sent straight to the ed team and bumped straight off the list and bloods were ran etc. If i purge they do tests.

    So i urge people also stress to your dr if they are ignorant enough to ignore the fact you may not look “ill” enough to run tests. If they come back normal….FAB!!!!!! if they dont…then you know!

  10. anonymous says:

    MV is so judgemental, it’s beyond disgusting. And I am recovered. Sometimes, Harshness backfires. Have you no compassion? I saw the whole I motified my post gig. PLEASE. It’s pathetic.

    • Anonymous says:

      As you said, if you think you have an ED, you probably do. Ed patients should by all means consult with a psychologist/ psychiatrist who know what they are doing. But if they need to seek urgent medical attention, they should get it and be educated to realize that the medical attention they are seeking is for medical purposes only…. NOT THERAPY. MD’s are necessary to administer medical care to those who need it. To expect or hold them to being an eating disorder specialist is completely unrealistic. That is not their job.

      Their job is to treat the medical crisis at hand. Ed patients should not expect medical Dr.’s to fix their psychological problems. Yes, I know many are insensitive and don’t know a lot about ED’s. But, if you are an internist or GP, IT’S NOT YOUR JOB TO. Their job is to treat the physical crisis at hand. To tell someone that if they are in physical danger from their ED to not see a medical Dr first is again, irresponsible. I strongly stand by that belief and I will not back down on it.

      People look up to you. I know you are not an expert and no, you don’t claim to be, nor am I. But common sense when it comes to one’s physical health is something I think that you as a healthy and recovered role model could have been more mindful about when advising this particular Ed Sufferer.

      I also recall a time where you actually posted the line on your own website… (It was some time back) “Anorexic’s… Just eat already.” It’s there somewhere. I remember it well. So, I find being critical of MD’s who say that rather hypocritical of you. And frankly, as much as I dread the phrase “Just Eat,” and find it gratuitous and insensitive- let’s face realty. While not simple, it is ultimately, the key solution in conjunction with psychotherapy. Have you ever heard of the Maudsley approach? I’ve always believed that you are well intentioned in your mission on the war against Ed’s. I truly do. But sometimes, I think you need to think a little bit more carefully before you type. Just my opinion….

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  12. NTG says:

    With regards to your update. I for one have never been turned away by a doctor but thought I’d share this story regardless. My apologies first off if it is TMI. My father when he was 38 was bleeding from his behind. Doctor after doctor turned him away and said not to worry it is a male thing. A few months went by and the issue got worse and the doctors still turned him away however he never gave up. He knew there was a problem and that this was not common. He finally saw a doctor who agreed they should look into the issue further. Turned out he had very advanced colon cancer and had to have a colostomy. Had he listened to the doctors and walked away he would have died. Now 32 years later he is still here and I am very grateful.

    Lesson I learned when you know you are right (and in the case of EDS, know you need help) don’t give up. It may take 1, 2, 20 doctors but don’t give up. It is discouraging as hell but the upside of getting better is worth it. Sometimes we have to work very hard to get what we want and if you really want to get better you have to work for it. No different starting inpatient, outpatient, etc. The doctors give you the tools but it is up to you to implement them and want to get better.

    For me getting better is worth it. It is very hard but I have to tune out the negativity and remember I am worth it. Probably gone off topic. Have a wonderful weekend!!!

  13. Anonymous says:

    NTG,

    I couldn’t have said it better. You can have the best Shrink in the world and if you aren’t motivated to get better, it aint gonna happen. It has to come from within you. It’s not easy.

    I’d also like to point out that there are as many quack psychologists and psychiatrists out there who claim to be experts on ED and are treating ED who have no fing clue pardon my Francois what they are doing. Not all- but many. That was a quote my father said once to an alleged renknowned facility I was in as a teenager. He was right. All I can say is if you are going to see a shrink, do thorough homework on their credentials, and also shop around. Finding a good shrink should be like an employer finding a strong candidate who’s best suited for a particualr job. Don’t be afraid to interview a few to find a good fit.

  14. mamaV says:

    Please see update above — the key word here is “first”

    I would never suggest not seeing a medical doctor when we all know we are talking about fatal illnesses here.

    Anyway you cut it, you need both. The order in which you see them is up to you.
    mV

  15. Shelly says:

    Yeah. A person should see a medical doctor FIRST. May therapists will not see a patient if they do not have a medical doctor they are seeing.

    I saw a medical doctor and she referred me to a therapist who specialized in eating disorders.

    • Anonymous says:

      I think that she did not realize when she posted this that it is often the policy of many therapists not to see an Ed patient without a medical exam first. I get that she’s not saying never see an MD at all, but a person making a decision to go into therapy which is a great and key first step needs to know that seeing a Dr. First is often a cardinal rule amongst not only therapists, but insurance companies. Many insurance companies will not pay for shrinks without a referral from an MD. This is important information to take into account when seeking treatment.

      • mamaV says:

        Actually that is not accurate. I saw a psychologist with no physical exam whatsoever. Perhaps I should have been required to see one, but in my particular case it was not a factor in treatment.

        The reason for the update was to simply clarify my opinion a psychiatrist/psychologist is a good first step, followed by a medical doctor — since obviously this is an important clarification!

        I understand we have high emotions on this topic, because we all have our personal experience and I think it is great that everyone is stating their story because that is what a blog is about.

        At the end of the day though, its you sitting alone, needing to make the decision that is right for you.
        Love,
        mV

        • Anonymous says:

          I would have to agree. If you are making the step to recover, I think that making an appointment to talk to someone about it is a great first step. Any therapist who is going to be a help is going to immediately suggest a medical doctor to make sure you are physically ok. I think the situation arises where someone who KNOWS they are suffering from and ED, go to a medical doctor for help, and when tests turn out ok, they think “well, I guess I am not sick enough to need help”. There is a HUGE stigma in the ED world for being “sick enough”. And how many times does it happen that someone ends up in the ER for an ED complication, gets “forced” into treatment, and the instant the medical doctors deem them healthy, they are right back to the same old tricks. Is a medical doctor necessary for recovery- absolutely (at least, most of the time- I personally did it without). But making the step to admitting you have a problem and trying to get help for it are SO key! Fixing the medical problems that arise from an ED will not make the ED go away.

  16. Anonymous says:

    MV,

    Just to clarify once again…. I am absolutley 100% accurate that MANY psychologists/psychiatrists/Insurance comapnies do INDEED require a medical examination or referral before getting psychological help for an Eating Disorder.

    To Clarify YET AGAIN… I said MANY. I did not say ALL. This is a fact. It depends upon a therapit’s personal policies in their practice and a person’s individual’s menatal health care benefits on their insurance plans.

    Please do not call me Inaccurate when I have been hospitalized four times for Anorexia, my parents spent I don’t know how many years of their life fighting insurance companies and shelping me to a million shrinks all with their own rules about treatment. You are the one who is inaccurate.

    Just because your therapist did not require a medical exam first does not mean that many don’t. And once again, just to be clear, I did not say ALL. I said Many. This is a plain fact and one I think people seeking treatment should know exsists. It may not apply in all cases depending upon the shrink or the healthcare plan, but it could. To say that I am inaccurate about this being the personal policy of some therapists or the policy of many healthcare plans is what is inaccurate.

    I understand you are making the point that it is important to get quality mental health for an ED and that is the point of your post. But if you are going to advise people to do so, then you should be aware that sometimes, it is a requirement that a medical exam be conducted first before a psychological evaluation.

  17. Ella says:

    I also want to clarify again that the key word is first. An ED sufferer should most certainly see a GP/MD FIRST. Not a psychologist. A doctor. Even if the doctor only runs basic tests; even if it’s ONLY an assessment of electrolytes, it is still important that a sufferer sees a GP first. Why? Because if you’re about to drop dead (and you won’t always know, let me assure you), all the therapy in the world ain’t gonna do a thing.

    I understand what you’re trying to do with this website; but sometimes it feels like you’re shooting yourself in the foot. You’re anti-pro-ana because the advice that they give people can kill them. Well, the advice that you’ve put up here could very well kill someone. If they take your advice and see a shrink before they get a medical clearance (and it doesn’t matter what eating disorder it is) – they could very well drop dead on the waiting list to see that shrink. PLEASE suggest that people see a doctor first.

    And no, doctors can’t ‘treat’ eating disorders. But they can clear someone medically and maybe save their lives.

    • Anonymous says:

      Ella, I totally agree here. Everyone is entitled to their opinion, but I am not sure why when she is not trained in the medical field she would suggest that a person not see an MD first. I really don’t get it and think it’s very dangerous and irresponsible advice. General GP’s do not have to be trained in Eating disorders to be able to recognize detrimental medical problems that can arise from them. It’s really beyond my comprehension. I happened to be at my own internest today for a cold who when I relapsed a few years back went to first. She knows I had a history ED and found all kinds of things wrong like low white count, B-12 and Vitamin D Diffiency, elevated liver enzymes, and anemia. Yes, I marched my ass back to therapy and doing ok now. But if I hadn’t seen her first and taken the appropriate supplements until I got to the shrink and nutritionist, I might not be alive typing this right now. I asked her what she thought of somone giving this advice to someone with an ED when they themselves are not a DR. Her jaw dropped.

  18. Danielle says:

    These comments are out of control. “Anonymous” keeps coming back, time and time again to read the posts… so much outrage in her comments…if you don’t like a blog, don’t come back!

    The most important step I ever took was going to a see a shrink first because she directed me to a doctor she knew of that was sensitive and knowledgable about ED. Every insurance plan I have had in the last decade allowed me to freely visit shrinks because I chose a PPO plan. Understandable that HMO plans require a doctor’s visit with a referral to cover a shrink, but you are still free to visit a shrink outside of using insurance.

    To all of the outraged readers… maybe a blog is not the right place for you. Medical journals, websites like NEDA, and published books by professionals might be a better source for expert advice. I stop by this blog for interesting commentary from a woman recovering from an eating disorder, and although I do not find every single word to always be the way I would represent feelings on a subject- I understand that this is someone’s personal blog. If I run across a blog that states that “fat people should be executed if they refuse to lose weight” or that “kicking puppies is a perfectly acceptable practice for a good time”… I move along and understand that personal freedom includes freedom of speech.

  19. Anonymous says:

    I am not outraged at all, and I don’t dislike her blog. I simply don’t agree with her on everything. She feels seeing a shrink first is the best step. I disagree and feel that this is not wise advice. Some people back me on this if you read above, and some people don’t. She and you are entitled to your oponions, as am I. That doesn’t mean I dislike her blog or her personally. In fact, I have said many times that I believe she is very well intentioned. I just don’t always agree with her opinions on ED. Part of having a blog is to spark conversation and share opinions. Not everyone’s opinion is going to jive with everyone else’s. When I disagree with her, she often misintrepts the points I am trying to make and goes on the defensive. I am not an ED expert, but I happen to know and have been fortunate enough have worked with quite a few of the most reknowned in the United States. I don’t think it’s wrong of me on an ED blog to share what I have learned from them and what they think about the subject when they have dedicated their lives to helping others and have published some of the most advanced research on ED’s.

    To suggest that someone not express their feelings on a public blog that invites comments simply because they don’t always agree with the position of the blog author is not fair. Like you say- freedom of speech.

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