Supporting your desire to live free from self-destructive behavior as you embark on a life long journey of recovery.

Category Archives: Live Free

Mental Health Awareness Month

Mental Health Awareness Month has been observed since 1949; and yet, mental illness is still poorly understood and highly stigmatized in our country today. 

Unfortunately, the vast majority of people continue to believe that psychiatric disorders are “made up,”” instead of viewing them as very real, potentially fatal, brain diseases. The truth is mental illness deeply impacts all aspects of a person’s life—their relationships, identity and behaviors. 

Possibly the greatest hindrance to widespread understanding and acceptance of psychiatric disorders is that they cannot be seen physically (in many, but not all psychiatric illnesses). What’s more, unlike cancer or other medical diseases, mental illness cannot be identified via an x-ray or blood test.  Therefore, a man hobbling on crutches with a broken leg is shown mercy; bystanders might assist by opening doors or carrying items. Conversely, a woman lying in bed with crippling depression is often extended no mercy whatsoever; instead, she is perceived of as lazy and is encouraged to snap out of it. 

In fact, depression is very commonly misunderstood in today’s world, primarily by patients themselves who tend to blame themselves for having the illness or being lazy (these are distortions associated with the disease!), and also by the very people that are most supportive of those with other medical illnesses–doctors and family members. 

Often a mother, father, wife or husband incorrectly uses themselves and their own life experiences as a unilateral barometer. They may recall times when they felt sorrow or despair in their own lives. In time, the sorrow passed or the despair lifted. In other words, they ultimately “got over it.” Therefore, the tendency is to apply this same standard to the loved one who seemingly can no longer function. The problem is, the standard is not applicable. The individual weighed down by clinical depression can no more resiliently bounce back than the other family member can fly. The bottom line is this:  if they could, they would; but they can’t all on their own. Give the family member who can’t fly an airplane and a pilot and off they go. Give the family member with debilitating depression good care (therapy, medication, supportive community) and they can recover. 

What an individual struggling with depression, anxiety, or any one of the other myriad psychiatric disorders truly requires is treatment; for many people this includes medication, which can help with the physical aspects of what the brain needs to recover from depression. Regrettably, due to the ongoing stigma   associated with mental illness, people routinely fail to get the help they need. Sometimes they refuse to seek therapy due to the shame they feel about seeing a counselor or psychiatrist.  Certain segments of the population are particularly vulnerable to this fear of stigma. Those in the military frequently go untreated due to the fear of jeopardizing their careers. Mothers, afraid their children might be taken away by a social service agency, are also often reluctant to seek care. Professionals many times avoid treatment because they have a career to tend to. Doctors and nurses do likewise because it’s their job to take care of others, not to receive care themselves. 

Fortunately, due to initiatives such as Mental Health Awareness month, we have made strides in the area of eating disorders and substance use disorder. Today, the public has a greater understanding and appreciation for the complexity of these two illnesses. Now, if we can just promote greater comprehension surrounding other mental illnesses like depression and PTSD, perhaps the blame and stigma might be lifted and people could get the support they require and deserve. 

Values

The world places a high value on certain things–money, happiness, thinness (sadly), comfort and security, to name a few. However, in our fervent efforts to pursue such conditions in our lives, we often neglect an essential underpinning to any living experience worth having: values. When we live unconsciously, blind to our values our lives become unbalanced. The same is true for people who profess to value certain things, but their actions tell a very different story.

Lack of balance is rife throughout our society. The business man striving so hard to get to the top in order to make huge amounts of money–for noble reasons that are applauded by society–to pay the mortgage and keep his kids in private school. The woman, who could easily be married to this man, who must be “perfect”: thin, industrious, beautiful, with equally perfect children involved in every possible after school sport and activity.

The truth is, this lack of balance is sustainable for a while. But soon, our business man, having sacrificed time with his family, time in the gym or stress-relieving sports to spend more time in the office, begins to rely on alcohol earlier in the day, and even more at night, simply to relax. And our woman, unable to cope with her many self-imposed demands, starts taking Adderall to keep up with her hectic schedule.

Even this offers a modicum of sustainability. But in the end, when we lose balance and succumb to self- destructive and addictive behaviors designed to sustain us in our unbalanced, achievement at all cost-oriented lives, we can find ourselves in a place we don’t want to be.

Without a single doubt, I lived this way as a young woman. In the end, no achievement would ever be enough to sustainably anesthetize the pain that arises from living a life disconnected from real values. In college and medical school, when I was fully in the throws of an eating disorder and getting more deeply sucked into alcohol, my only priority was becoming a doctor. Various moments of clarity, fostered by loved ones and strangers alike, helped me to see that left unchecked, my eating disorder would kill me before I’d ever graduate from medical school. My priorities were off, and my life was unmanageable–despite the fact that I was still showing up, and meeting the demands, of school. From as far back as I can remember, it never occurred to me that my health and wellness needed to be my first priority.

In my recovery I have gained a whole new respect for the necessity of balance. This concept grew in importance as my life got more and more abundant–a career doing what I love, a dog (another living thing to love and take care of), marriage to a man that I love with step-children I also love, and most recently, the grandest gift I’ve experienced in recovery, motherhood.

My work has been, and always will be, tremendously important to me. I have personally worn the chains of addiction, which is why I choose to spend my professional life helping others to gain the freedom that I enjoy. Today, I am firmly and consciously rooted in my values, with my own recovery and health topping the list. My behaviors and choices reflect my values (most of the time!).

Beginning SunCloud is one example of this in my life. Not only is it consistent with me keeping a positive work/family balance, it has given me the latitude and opportunity to fulfill a long-held dream: to create a fully integrated treatment center that offers the comprehensive care required to help people truly heal, one that values health and wellness first and foremost for every single patient and family–a place with values that are aligned with mine.

The Problem With Parity:  It Doesn’t Exist

The American public willingly exists under many myths: the tooth fairy is real; love always lasts forever; one size fits all.  Belief in such myths is basically harmless.

This one is not: the myth of mental health parity.

Far too many people labor under the notion that insurance coverage for mental health issues is equal to that for problems of a physical nature. After all, wasn’t that legislated by the federal government a while ago?

Here’s the answer:  no.

Every single day, we on the outpatient side of things, fight insurance companies to provide just one more day of care for those struggling with severe depression, an eating disorder, or substance addiction with co-occurring bipolar disorder or post-traumatic stress disorder. What does this translate into in real terms? Approximately $400 at the outside. And yet, a recent patient of mine, who was also a physician, told me about a surgical procedure in which the doctor elected to use a new semi-synthetic mesh product to close a patient’s abdomen, without making a single phone call to an insurance representative. The cost: $10K.

Due to much coverage by the media lately, there is now widespread awareness of opiate addiction throughout our country. This increased awareness is extremely positive on many levels. Yet again, a severe disconnect remains in the minds and hearts of insurance companies.

A patient of mine nearly died from an opiate addiction. On his current insurance plan, the co-pay for narcotic pain medications such as vicodin, oxycodone and morphine is literally nothing; it is essentially free. However, a prescription for suboxone, a medication that actually treats opiate addiction, requires a co-pay of $80 a month. Mind you, this is only after I, as his physician, spent 15-20 minutes on the phone with the insurance company to get the authorization required to treat him with this potentially lifesaving adjunct to his treatment.

Several roadblocks already exist for those with the disease of addiction. The stigma associated with substance abuse is very real and frequently proves a huge deterrent to accessing treatment, especially for those in the military. Moreover, instead of viewing addiction as a genuine illness, too many people continue to perceive it as a moral failing. Denial, a core symptom of many mental illnesses, keeps untold numbers of individuals from treatment. Add to this, a health care system that sets up serious barriers to both the patient and the treatment professionals and you have a perfect storm in which people remain addicted until they die, often due to overdose.

All of us need to be conscious of this ongoing injustice and question it whenever we can. Additionally, we must be grateful for groups like the Kennedy Forum, NAPHS, REDC and the Parity Implementation Coalition for working specifically and diligently on this issue of lack of parity. Only through both awareness and action will we witness much-needed change.

Vulnerability and Truth in Recovery

Vulnerability and Truth in Recovery, by Shale Marks, LSW, CADC- Therapist at SCH

 

Several months ago I was looking at a journal entry written by a 17 year-old me and there were eight words that leapt from the page, which animated my spirit with a warmth and preciousness that made my heart swell. My 17-year-old self had written the words, “I think I’m finally starting to get it.” I look back at the boy I was then and hold him up to the light with compassion. I smile at the notion that he thought he was finally starting to get “it”. All these years later I realize that the greatest wisdom in the world is to know that I don’t know. This is the ungraspable truth that comes to many in recovery and what I as a clinician try to impart to our patients at SunCloud Health – that it’s okay to not know. It is okay to not be okay. In fact, the farther along we get in recovery, the more wonderful it feels to be able to say the three hardest words for us to say, “I don’t know.” As Brené Brown eloquently states – this is the power of vulnerability. It is from our weaknesses that we find our strength and sometimes what seems to be our final hour, often becomes our finest hour.

 

What was the “it” that I thought I was starting to get?

 

My first career was as an actor. I moved to New York City when I was 18 to pursue acting because performing ignited something in me that gave me access to a personality that I did not know that I owned. Often, people pursue a career in acting because it provides the space and opportunity to be somebody else for a few hours, to take an audience in and convince them that what is happening on the stage is actually occurring. But for me, it was just the opposite. When I was performing on stage or in front of the camera, it was when I felt most like myself. Acting gave me access to the present moment, a place I had rarely visited. Today I can access to power of the present moment anytime I like. This is the primary gift of grace in recovery.

 

My first Christmas in recovery was a dismal one. The day before Christmas, I was depressed because it was the day before Christmas. Christmas day, I was depressed because it was Christmas day and the day after Christmas I was depressed because it was the day after Christmas. I now realize two things about that Christmas. First, I am not a Christian. Second, it had nothing to do with the holiday and everything to do with an internal condition, which seemed utterly hopeless.  It was what we in recovery often refer to as the hole in the belly that the wind blows through, a divine dissatisfaction, an unsatisfied God-hunger or an unquenchable thirst.

 

Not too long after that Christmas, I began to see that recovery can only begin when a person realizes that the problem is not external, though external conditions can certainly contribute to dis-ease. Recovery is now and has always been an inside job. And what of the “it” for which I yearned – the itch that couldn’t be scratched? It is always available in the here and now. The present moment isn’t just something sandwiched between the past and the future. Contained within the present moment are hope, possibility, an internal revolution waiting to be quickened and a stirring of love, which we all have within us. We simply have to open our eyes to see it and if you can’t find it on your own resources in this holiday season, there is help available. Light and love. 

 

Shale Marks, LSW CADC

A letter of hope for freedom, from an anonymous former patient of Dr Kim Dennis

In hindsight, I’ve always hated my body. I took up too much space. I couldn’t be contained. Thus, it started with diet pills, the good kind. I stole them from my mom until she bought me my own which confirmed what I thought. I was too much.

I never could remember what life was like before we moved to Texas, just outside Dallas. I was 13, 12 maybe, going into the 7th grade. My dad, an alcoholic. My mother, a perfect Al-Anon. Life was tumultuous at best. Each day carried a singular, unspoken goal: ‘don’t upset your father.’ My sister (6 years my younger) and I tried our best. Inevitably we would fail and he would rage. Sis always took the brunt for some reason, despite my best efforts. He never actually put his hands at us (not at that time, anyway. maybe? it’s blurry), but there were many a hole in the wall and items being thrown.

My first drink was at 15? 16? I had ‘waited’ because I didn’t want to be like him. It was completely unremarkable, to be honest. I did feel a part of; the cooler varsity players let me hang. I was a baller too. But not like them. Remember, I was too much. Too much to move fast like coaches wanted.

The eating disorder was in full flight by my senior year of high school. And so was my dad’s drinking. Mom, the glue, had taken a job promotion in another state. And so went my sanity. I was my sister’s parent. It was dark. Little did I know college would be darker. Collegiate basketball and softball kept me straight for a while but I was still bankrupt inside. Out of control restricting-Bulimia, purging 10x a day, self-harm. Drinking became more than mere habit. More than anything I was plagued by depression and suicidality. This lead to the campus counselor, to the local psychiatrist, to the psychiatric hospital. From there I would be transferred to an ED facility near Houston. It was in this facility that I would be introduced to the world of drugs (and a relationship with a tech employed there). 104 days later I emerged, sicker than ever. I started Grad School – Psychology ironically. I began running back and forth from school to Houston to pick up drugs and to maintain the relationship. One fateful weekend we decided I should try my entrepreneurial hand at selling prescription pills back at school. I loaded up. And was subsequently arrested a little more than half way home. I would later be indicted with a felony possession charge that haunts me to this day.

At the time of the arrest, Mom decided ‘drug dealing’ was not the reason she was paying for room and board. So I came home to Dallas and started trying to get sober. Started. Trying. Five (ish? I lose track) psych hospitals later. Another ED facility later. A suicide attempt later. It’s June 17, 2006 and I am finished. I do the best I can – trust God, clean house, help others – but I can’t shake this deep deep shame and need to destroy myself. I know the previous vices don’t work anymore. I start to feel nothing short of completely f’ed.

I am at least 6 years sober when the flashbacks start. The first 13 years of my life, flooding back in and I begin to realize…there’s a reason it was blacked out. It was the babysitter. And her son. And her husband. It was horrific. It was daily. It was for 6 years. It was maybe my dad too.

I am 8 years sober when I land at Chicago O’Hare and I want to die. I am in ‘this place’ again, I am institutionalized again, I am hopeless again, I am wondering what the point is…again. I am sober. By some miracle of God (truly) I meet Kim – Pine Lodge, Group 2, Process Group. I am instantly hooked. I am baffled. She knows what she’s talking about. Not because she read it in a book…no, this woman has LIVED what I have lived. And she’s on the other side and incredibly successful. I want EVERYTHING she has. The success, sure, but mostly the peace. I am chasing the peace. I am forever changed by Timberline Knolls in Lemont, IL. I miss it every day.

I am 10 years sober as I approach the end of my M.A. in Professional Counseling. I am not fully healed; but I am on the path. A path that’s headed toward freedom, a freedom of MY choosing. I have moments of the elusive Kim-sized peace. I am certain I can help others. I am hopeful.

Gratitude- Not Always Easy To See, but Always There- by Dr Kim.

Thanksgiving has come and gone with Christmas fast approaching. Many referred to this as the season of giving, which is certainly a fine concept. I like using this holiday as a season to intentionally practice gratitude, a practice that we may embrace right now and then continue to develop a day at a time far into the New Year.

All of us, even in our darkest times, have at least something for which we are thankful. The fact that I am writing these words and you are reading them indicates that we are far more blessed than many in the world today. We are literate, safe, warm in the winter months, and have access to food, clean water and clothing.

When I first entered recovery, gratitude was extremely difficult to find. I would try so hard each day to dig up even one thing to appreciate in my life. On very challenging days, the only thing I could consider to be grateful for was I could breathe. And some days, even that did not feel like a blessing.  That was a dark time, indeed.

Today, I can easily name two handfuls of wonderful things without even breaking a sweat! My life is rife with positive experiences, events and people. I had blessings in my darkest times as well, but I was blind to them. Like so many, I was robbed of my vision by the diseases that threatened to take my life, and the traumas that created them. I had not yet developed eyes attuned to seeing the light. Today not only do I have such vision, best of all, I get to help men and women who come to SunCloud to develop theirs. They are exactly where I was.

And there within lies one of the beautiful aspects of the power of gratitude; if given a chance, it leads to hope. By and large, we are thankful for certain things because there was a time when we didn’t have them. Years ago, I did not have my husband; I did not have my step-children or my son. My life was defined by addiction and misery.  I could not have possibly imagined a future that was not only freedom from addiction, depression and ill health, but a life experience filled with abundance.

And neither can those who walk into our treatment program.

But all of us at sunCloud can imagine it for them.  We can create and hold a positive vision of their future lives within our hearts. Essentially, we serve as holders and see-ers for our patients. We stand in a symbolic line of hope for them because they cannot stand for themselves.

We know one simple and powerful truth:  if these hurting people engage with us and allow us to help them, their bodies will heal, their minds will unwind, their souls will flourish. Hope will ignite. They will take their rightful place in that line, a line that leads to a future of health, healing, joy and abundance.

Children: Today’s Unseen Casualties

When a war between two factions is in progress, the media routinely reports on casualties. Newspapers often chronicle the number of dead on the battlefield, while other outlets offer statistics as to how many combatants were maimed or mutilated during a particular skirmish.

In either case, the overall toll could be in the hundreds or thousands. In time, the statistics blur. We are no longer shocked or outraged by the numbers; instead, we become inured to what these numbers actually reflect.

Until…The morning a war correspondent posts a photograph of a toddler stranded in a bombed-out building, clutching a stuffed animal.

Then, everything changes.

Humanitarians take notice.  Bystanders decry the war. Governments become involved.

Why? Because the horror of war was instantly reduce to one innocent child.

America is engaged in a war right now. One camp consists of doctors, parents, law enforcement, and many others. All are fighting the same enemy:   opioid addiction. Whether this addiction is the result of heroin from Mexico or oxycontin from the local pharmacy, this disease is powerful, indefatigable and takes no prisoners.

The numbers of addicted and dying are staggering; so much so, that the statistics are beginning to blur.

Until…The Washington Post printed an article on the seven-year-old who told her bus driver that she was unable to wake both of her parents that morning. Investigators found them dead from an overdose. Three other very young children were in the house.

It is the children, the ones we rarely read about, who are the unseen casualties of this particular war. How many thousands upon thousands of children in our country today are homeless, left orphaned, on the street because the enemy won that particular skirmish? Far too many. Not to mention the profound effect on children of growing up with the chaos, insecurity, emotional neglect and all forms of abuse associated with addiction.

I have the incredible privilege and joy to be the mother of a 23-month old son. Daily, Samuel relies on his parents to provide everything of value:  love, security, acceptance, shelter, food, companionship; everything from a warm nighttime blanket, socks and sturdy shoes, to structure, consistency and emotional availability.

And this is precisely why the young girl on the school bus is today’s toddler in a war zone.

She, and her three siblings, undoubtedly depended on her parents exactly as my son depends on my husband and me. Those kids were totally dependent on their parents, and now those parents are dead from the disease of addiction.

American must win this war against addiction that is claiming the lives of so many each and every day. We must continue to educate the public as well as physicians about the risks of addictive medications, we must continue to educate physicians about identifying and treating the disease of addiction,  to prescribe appropriately and get those addicted to the treatment they need.   Simply because when addiction wins, it’s not only the person who dies that loses, but anyone connected to her, including and especially her children.

“Both, And”… Not, “Either, Or”.

More from Dr. Kim and SCH On The Compatibility of 12-step and MAT

The initial step of any successful treatment is patient engagement, establishing trust and hope, and collaboratively designing a treatment plan that the individual buys into. The evidence base for opioid use disorders has consistently shown that opioid replacement therapy (classically referred to as “harm-reduction”) yields far better outcomes and mortality rates than so-called “abstinence-based” approaches. In part, this is due to much higher treatment retention rates when patients receive appropriate medications for the physical aspects of the illness.   Instead of being consumed by cravings and withdrawal symptoms, individuals have a better chance to form trusting relationships with treatment providers who can help them, and peers in recovery who can support them unconditionally along the way.

For as essential as medication can be for many people in treatment, it alone is usually insufficient to keep a person in long-term, sustainable recovery. There must be additional treatment components to address the myriad facets of the illness.  We must address depression, bipolar disorder, anxiety disorders, eating disorders and post-traumatic stress disorder, all of which commonly co-occur with addiction.  Evidence based-treatments targeting the emotional, social, environmental and spiritual domains of addiction include (but are not limited to) CBT, motivational interviewing, DBT, nutritional therapy, and 12-step facilitation (a topic often wrought with resistance from professionals and lay people alike).

There are many reasons why people resist going to a 12-step group; most are related to misconceptions of the fundamental tenants of the 12-step approach or a previous experience with unhealthy groups or individuals. The goal of 12 step participation is ongoing sobriety, along with sustained social, emotional and spiritual growth. The 12 steps serve as guiding principles of recovery for those with any type of addiction and the 12 traditions serve to guide the behaviors of groups as a whole.

One of the most relevant traditions with respect to MAT/12 step model controversy is the single-ness of purpose tradition, which encompasses the idea that “We have no opinion on outside issues.” Medication is considered an outside issue in healthy 12 step groups.  Sponsors are not doctors. And for those who are doctors, their role as a sponsor is simply to share their experience, strength and hope regarding one area: how they work the steps to thrive in life and remain sober. Much of the push back against medication use by some individuals in 12-step groups is predicated on the definition of sobriety.

Those opposed to MAT claim that relying on medication is simply addiction shifting; in order to be genuinely “clean [do we refer to cancer patients as clean or dirty???],” they believe medication cannot be used. The truth is, for a person with an opiate addiction, part of being sober means authorizing an expert addiction doctor to manage his or her medications rather than a drug dealer on the street.  This is no different than an individual who takes an anti-depressant to treat clinical depression. Some people will need anti-depressants for their depression regardless of how well they work all 12 steps.

Often the implication from opponents of MAT is “if you didn’t go through hell like I did, then you don’t deserve to be in this meeting with those who did.” The implicit message is that those with addiction must endure more suffering to learn their lesson and finally recover. “Inclusion based on degree of suffering”? This makes no sense. Everyone with the disease knows pain.   Additionally, at its very heart, this mindset is judgmental and stigmatizing, which is antithetical to all that 12-step recovery stands for. Meetings are intended to be a safe, accepting place where unconditional acceptance of individual differences regarding the path of recovery is paramount.

Recovery doesn’t happen in a vacuum.   ‎Recovery happens in community, not just any community, but a healthy, compassionate, accepting, and well-informed community, not one based on intolerance and judgment.

 

 

 

 

Using medication assisted therapy and 12 step to treat opioid addiction?

Everyone seems to agree that we have a profound opioid epidemic throughout our country. However, there remains a high level of controversy regarding how to treat opiate addiction. This is particularly the case when discussing medical assisted therapy (MAT) and 12-step facilitation.

Many people maintain that these two approaches are incompatible–with MAT viewed as “harm-reduction” and the 12-step model as “abstinence-based”.

I hold the radical view that MAT and 12-step facilitation therapy are not only compatible, but when used together provide patients with robust, evidence based treatment for a potentially fatal disease. Providing only psycho-social-spiritual support without physical/medical intervention and vice versa is universally considered inadequate treatment. Sadly, it happens all too often that a person receives one or the other and not both/and!

Anonymous SCH Patient Perspective “One of the best things about Dr Kim is the fact that she had been there herself, and she gets it. She understands better than anyone that there is no universal treatment that works for everyone. We all need and deserve to be treated with the sincerity and openness that Dr Kim brings to treatment.”

Much of the controversy between the two lies in semantics. All forms of treatment are fundamentally harm-reduction and can also be considered abstinence-based—that is, when we use a more sophisticated definition of abstinence than “using no substances,” and a more sophisticated definition of harm reduction than “still using substances.”

For example, a person abstinent from alcohol in AA is reducing harm to their physical, emotional and spiritual health by not drinking. The fact that the person is abstaining from alcohol does not necessarily mean that other self-destructive thoughts and behaviors have been extinguished. The abstinent person early in recovery usually has a long road of emotional, physical and spiritual healing ahead in order to let go of other problematic ways of thinking and behaving.

In my view, the person with an opiate addiction who no longer shoots heroin from a street dealer but takes an opioid replacement medication from his addiction psychiatrist as prescribed, and engages in mutual self help groups, is abstinent. He is reducing harm to his well-being, reducing morbidity, and is abstinent from getting drugs from a dealer with no training or investment in the individual’s well-being.

An alternative, perhaps more accurate, definition of abstinence than “I don’t ingest anything that affects me from the neck up [imagine this being said with conviction by a “sober” man drinking a coffee and smoking a cigarette outside a 12 step meeting],” is “using no illicit substances or drugs other than those prescribed by a doctor who is equipped to treat people with the disease of addiction.”

And doctor-prescribed medication only takes care of the physical aspects of this multidimensional disease called addiction.  Unless the other dimensions–psychological, social and spiritual—are addressed as well, the treatment is insufficient.

Anonymous SCH Patient Perspective: “The team at SunCloud is incredibly passionate and I feel like they actually care about my recovery. They didn’t label me when I walked in the door, they take the time before during and after treatment to help me and my family and they treat us all like individuals whose paths are unique and special. I wouldn’t go anywhere else. Dr Kim deserves the reputation she has earned over the years.”

Tell Me I’m Fat

Written by Victoria Krone, AM, LCSW, Clinical Director, SunCloud Health

A few weeks ago, This American Life, produced by Chicago Public Radio, ran an episode called “Tell Me I’m Fat.”  I was in my car, driving home from work, as the episode came on air: “The way people talk about being fat is shifting…maybe it’s time to rethink the way we see being fat.”  Initially, I took that to mean that this episode would challenge listener’s prejudices surrounding people of size.  That this episode was going to provide a more nuanced look at obesity—perhaps touching on the psychological and compulsive behavioral aspects that often go hand in hand.

The first segment of the show aligned with my expectations. Ira Glass interviewed a woman who described how she went from feeling ashamed of being a larger woman to embracing her size and loving herself.

The second segment; however, left me concerned about what some listeners might hear and take away from this show.  The central story in this segment, is that of Elna Baker—comedian, writer, and NPR staffer.

Here is a transcript from part of the episode:

Elna: I lost weight so fast– close to 100 pounds in 5 and 1/2 months– it was like going from one human to another. Here’s how I did it. I enrolled in a weight loss clinic. The doctor gave me a list of foods I could eat and told me I had to exercise daily. Your diet will be aided by medicine, he told me– potassium, serotonin, dopamine, a multi-vitamin, and then phentermine, which would help suppress my appetite. I look down at the little colored tablets. Skittles, I thought, only the opposite. I began my diet with a prayer for grace. I was Mormon then. I asked God to give me the same willpower Jesus had when he fasted in the wilderness for 40 days. I prayed for his self-control. Then I took the first pill, phentermine, which is similar to amphetamines– speed. I’d never done drugs before. Remember, I was Mormon. I’d never even tried coffee.  I didn’t know how a substance could alter your state of being.”

Before continuing with Elna’s story– a little more on Phentermine. Phentermine is a stimulant similar to an amphetamine (think stimulants like Cocaine and Speed). It acts as an appetite suppressant by impacting a person’s central nervous system.

The official Phentermine website indicates that 32% of phentermine users report experiencing rapid heartbeat as one side effect of taking phentermine, while another 22% reported “phen-rage” (extreme anger), and another 3% experienced psychosis.  The website also endorses that users may develop emotional and physical dependence on phentermine and develop the following withdrawal symptoms: nausea, vomiting, trembling, nightmares, changes in personality, irritability, weakness, depression….anything sound familiar?

Phentermine is a drug with addictive properties (withdrawal, reinforcement, tolerance, dependence), and the people who turn to it and find “success” with it are those who have replaced one addiction (to food) with another (Phentermine).

So, back to Elna’s story:

“Here’s something that surprised me. It wasn’t enough to take diet pills. It wasn’t enough to lose the weight of an entire adult woman from my own body. Once I did all that, I realized I still wasn’t actually thin. Not really. After dropping the weight, I had so much extra skin that I could lay on my side and pull it a half-foot in either direction.

For a long time, I tried to get the skin to go away with lotions and exercise. Eventually, I resorted to surgery– in fact, four different surgeries. They included something called a circumferential body lift. They made an incision around my entire waist, cut out a 6-inch belt of skin, and then sewed me back together.

I also got a thigh lift. They cut up my legs from my knees to my groin and took out as much skin as they could. Now I have a scar that runs completely around my waist, as if a magician cut me in half. I also have two scars running up my legs like inseams.

In order for my legs to heal, I had to sit alone in a room for a month without any underwear and my legs spread eagle. It’s OK. I made it through every season of The Wire. But it was a painful month. One night, I went to pee, and the incision along my crotch split open two inches, not unlike splitting the crotch of your jeans, except it was my actual crotch.

I called the doctor in a panic. He told me he couldn’t sew it back up together without a risk of infection. So I had to pack the wound with gauze and keep packing it. I tried to pack it myself, but I was too hurt to move. As I bent forward, I heard it split even more.

I called my friend Andrea sobbing. She was at my apartment within five minutes. She came in holding a bottle of white wine and two Valiums– one for her, one for me. She had me lay back and pushed wads of gauze in my leg crease like she was putting the stuffing back in a teddy bear. But even surgery couldn’t remove the extra skin entirely. When I hold my arms and legs out, I still look like a flying squirrel.”

Elna’s narrative is recounted in a way that feels painstaking and exhausting—for narrator and audience alike.  It’s the type of narrative we endure with the expectation that a silver lining is around the corner—that this story will end with a resolution, lesson learned, advice for the audience.

Instead, Elna ended her story with an honest reality:

“Here’s something I never tell people. I still take phentermine. I take it for a few months at a time a year, or sometimes it feels like half of the year. I can’t get it prescribed anymore, so I buy it in Mexico or online, though the online stuff is fake and doesn’t work as well.

I have a shirt that says, “I’m allergic to mornings.” Everyone who knows me knows I have problems sleeping at night. I am usually up until 4:00 AM. I say I have insomnia. Really, I am awake because I am on speed. And I am on speed, because I need to stay thin. I need to stay thin so I can get what I want.

I know how this sounds. I know exactly how messed up it is. But I also feel like I can’t be honest with you, like we won’t really get anywhere unless I admit it. I’m taking it right now, by the way. I took it at 11:00 AM this morning. I will take another one at 4:00. I was on it to lose weight for my wedding. And now I’m still on it because I’m about to pitch a TV show in LA, and I need to lose even more weight.

Phentermine turns off the part of my brain that thinks about food. When I’m on it, I can legitimately say, I forgot to eat. I’ve thought before that it may be affecting my health. It feels that way. I’ve intentionally never googled the side effects.

I know that all of this is wrong. I don’t like what I am. But I’ve accepted it as part of the deal.”

And that’s how WBEZ ended Elna’s story.

I can’t blame them for the lack of a satisfying narrative arc—their job, as reporters, is to share the objective details of a story.  But I certainly hope they have taken steps to support their employee in getting the treatment she desperately needs.   Elna has a very serious eating disorder; and sadly, the physicians and surgeons she trusted to help her, only supported and furthered her disease.  Elna initially approached a doctor at a weight loss clinic and depended on this person, as a medical professional, to give her sound advice.   Instead, he handed her a script for a new addiction.

Elna says she is too afraid to research the health effects of Phentermine; yet we know, just from what she shared, that she has: sliced apart her body numerous times, put herself at risk of infection, regularly skips meals, has suffered emotional effects, completely disregards her body’s needs and hunger cues, and rarely gets a restful night of sleep.     As a professional who has worked with people with eating disorders for many years, I can also add to the list: she’s put herself at risk of getting Osteoporosis,  she is likely suffering from malnutrition, she has interfered with her body’s natural metabolism,  she’s likely to have Amenorrhea (absence of menstruation), low energy, and even impaired cognitive functioning.

Neither Phentermine nor weight loss have solved Elna’s problems—if anything, she describes herself in a darker place than before.   This is another example of why our fragmented medical system needs an overhaul; and why we need to begin treating people (not their symptoms) in a far more comprehensive way. The doctor who Elna initially saw, honed in on a “solution”—weight loss—without any evident attention to the underlying reasons she might be overweight.  Did the doctor run lab work? Did he rule out Thyroid disease? Did he take the time to determine her natural set point?   It’s especially unlikely that he referred her for a psychiatric assessment or that he required she work with a nutritionist (with knowledge of eating disorders) before prescribing Phentermine or suggest she engage in weekly therapy.

If Elna were given proper treatment with a team of specialists working together, it’s likely that she could have achieved a healthy weight without needing surgeries and without substituting one addiction for the next.   I hope this isn’t the way Elna’s story will end, and that after airing her truth so open and honestly, that those who are closest to her will help her to accept the treatment she so clearly needs and deserves.

No one should have to end their story: “I don’t like what I am, but I have accepted it.” Live Free.

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