I have not been feeling well for months. -low energy, aches and pains everywhere, chills, and chronic fatigue. I’m so exhausted that I can barely make it from my bed to the couch downstairs without feeling drained. At first I thought maybe it was depression, but as the months went on, I started to get this feeling that there is something deeper going on with me aside from depression. I have a history of thyroid issues in my family, and I’ve been told by a few doctors that I should keep an eye on my thyroid levels, as they have historically been on the lower end of the spectrum.
Thus, after months of feeling like total crap, I picked up the phone and made an appointment with an endocrinologist, hopeful that this doctor will give me the answers I am looking for. I scheduled my appointment for the end of December – and what did I do immediately after I hang up the phone?
I agonized over the appointment. Every day that it got closer to me having to go to the doctor, I felt my anxiety increasing. I loathe going to the doctor. In fact, I’m petrified. And here is a little glimpse as to why doctors appointments, for myself and many others, are often traumatic:
My recent appointment with the endocrinologist went as follows:
I arrived, checked myself in for my appointment, got my temperature taken, and was called back by one of the techs.
“Step on the scale please,” she says. I respond “Oh, no, I am in recovery from an eating disorder and I cant – ” She cuts of me off. “Ma’am, we really do need your weight if you’re going to be a patient here.” I feel myself starting to shut down. “Ok dont be a big baby, just get on the scale” I think to myself. As I step on the scale, I say to her “Okay but it’s triggering to weigh myself so can you please not tell me what my weight -” She cuts me off again to say my weight out loud in front of multiple other people in the office so that someone else can write it down.
And then the shame starts. I start sweating. “Oh my god oh my god that bitch yelled my weight out to the whole office everyone is going to know my weight oh god I cant breathe.” I walk into the room to wait for the doctor. Soon enough the doctor barges in the door and says hello without making eye contact. She sits down at her computer and asks me deeply personal questions without looking back at me one single time.
“You wrote down that you have PTSD?”
My heart sinks right into my gut. I stammer on my words as I try to give a 15 second elevator speech about my trauma to a woman who isn’t even looking at me. As I finish speaking I start to cry into my mask. “Why couldn’t I just tell her I wasn’t comfortable discussing it?” I think to myself. But I cant help it. I’m with an “authority figure”. I’m playing out my trauma – giving my all to a person who promises to help me but doesn’t actually care about me.
She types on the computer in complete silence for what feels like 15 minutes. She gets up, touches my hands, my ankles, my neck, my chest, and says “There doesn’t seem to be anything wrong.”
I finally start to get angry. “That can’t be right. I’m telling you, I don’t feel well. I know when something is wrong with my body. I am in recovery from my eating disorder and eat better now than I ever have in my life and somehow have put on an excessive amount of weight in the last few months that has me extremely concerned about my health.”
She says “Well, I’ll send you for more bloodwork but in the meantime, you should exercise, 20 minutes a day. Sound good?”
NO THIS DOES NOT SOUND GOOD, DOC. If exercise was the f&%$*@! answer, I wouldn’t be here talking to you, now would I? The problem is that I do exercise, perhaps not as much as I would like because I’m so exhausted I can barely function but I do my damn best. I’m not here because I needed you to tell me to exercise. I’m not here to talk about how to lose weight – I’m here because everything in my body is screaming “SOMETHING IS WRONG.”
But I dont say any of that to her. Instead, I nod through my tears “Yes, I’ll exercise.” and I am sent to the front desk to check out. The woman hands me a piece of paper with the summary of my appointment, in which it says that the doctor discussed BMI with me and I agreed that I was going to exercise every day for 20 minutes.
And I sobbed. The discharge summary said nothing other than that I am overweight and need to exercise. I threw it in the garbage because IT IS garbage. Why why why can we be so obsessed with someone’s weight but be completely oblivious about the trauma that is often behind the number on the scale? Why are we still even talking about BMI? There is a plethora of research negating its validity as a tool for determining health.
How differently could that appointment have gone if she had asked me what is going on in my life aside from exercising? If she had looked me in the eye when she walked in the door and made me feel seen and heard? Would I have been so horribly triggered if they had respected my right not to step on the scale? I guess I’ll never know, but I do know one thing:
This sort of stuff happens in doctors appointments over and over and over again. Folks who are struggling with eating disorders are often masking trauma. When you get to the root of the trauma, you mitigate the eating disordered symptoms. The person then learns how to listen to their bodies and eat intuitively, and their weight becomes whatever it is meant to be.
WEIGHT WILL TAKE CARE OF ITSELF. It is not necessary for doctors to be discussing BMI when 90% of the time, we don’t show up to the doctors to discuss BMI. Weight isn’t, despite what so many people think in this fat-phobic society, the root of all evil. Unprocessed emotions, underlying autoimmune diseases, irregular metabolic functioning, and suppressed trauma, are just a few of the many, many things that are more important than BMI.
I wasn’t given the time of day by this doctor, as has been the case with dozens of other doctors. Instead of leaving with answers for what is going on with me when I know something is wrong, I left full of shame and rage that no one will listen to me when I am doing everything short of screaming at the top of my lungs “SOMETHING FEELS OFF WITH MY BODY PLEASE HELP.”
I’ve been in recovery from my eating disorder for awhile now. I’m more in tune with my body than ever before, but because my BMI labels me as being overweight, everyone jumps to the conclusion that it must be my diet and exercise that are off.
We need to do better. We need to get rid of the BMI are start assessing people’s ACE scores (see https://alyssascolari.com/understanding-adverse-childhood-experiences/ for more info on ACE scores) because this is ultimately what’s going to kill people, not their BMI. You can put someone on the biggest, best diet in the whole world and they will still continue to have health issues until you get to the core of their wounds.
“Trauma-informed” is not just some training that we need to get in order to check off another box on our “to-do” list. It’s a crucial part of the work that all healthcare professionals do. When we start to shift our focus towards a truly trauma-informed practice, I can guarantee that we’ll start saving more lives than the BMI chart ever has.
I could easily (and I will one day) record an entire podcast episode on gaslighting and the damage that it does to one’s psyche. However, let’s take a moment to talk about it on the blog.
Gaslighting is one of the number one problems that I see when people come to me for therapy. Those who have been subjected to gaslighting often come into therapy confused, scared, and fairly certain that they are “sick”, “mentally ill”, or “crazy”.
By definition, gaslighting is a type of psychological manipulation that can be very subtle but oh so insidious. It is an attempt to make someone question and doubt their own memories, thoughts, feelings, and their perception of reality as a whole. It is not something that occurs only with romantic partners, but rather, this form of psychological abuse (yes, it IS abuse) can show up in friendships, with family members, and even from colleagues in the workplace.
Metaphorically speaking, gaslighting looks a little bit like the following:
You: I know how to ride a bike, I don’t need help.
Abuser: Okay cool! You’re right. You got this!
Abuser: ~puts a giant rock ahead in your path, watches you hit the rock with your bike and crash~
You: What the heck? That rock wasn’t there before. I take this bike path all the time!
Abuser: Hmmm, maybe your memory isn’t what it used to be. I’ve never seen that rock before. You must be imagining things. I mean, I know you said you knew how to ride a bike but it looks like you really do need my help after all. It looks like you’re not as independent as you thought you were…Come here, let me rescue you. I’ll help you clean yourself up and maybe next time you should listen to me. I only want what is best for you.
You: ~left feeling confused, frustrated, guilty, ashamed for thinking you could do anything on your own, angry but unsure why, lacking in confidence, etc.~
The gaslighters in your life want you to think that they want the best for you. They tell you they love you unconditionally, but believe me you, there are conditions. They tell you they want you to grow and flourish and be the best version of yourself, but as soon as you start to do that, they pull back, throwing in confusing and hurtful comments, insinuating that you don’t really know what you’re doing in life, that you aren’t quite ready to “fly on your own” yet, that maybe you aren’t as great as you thought you were. They may also send you hints that you are too needy, but when you stop needing them, they ice you out or retaliate in ways that leave you feeling hurt beyond your wildest imagination.
If any of this sounds familiar to you, please know you are not alone. More importantly, please know that you have nothing to be ashamed of if you had no idea you were a victim of gaslighting. On a personal note, it took me 4 years to realize I was a victim of gaslighting. I believed wholeheartedly that this person had my best interest at heart, despite being hurt over and over again and despite feeling confused and worthless after every conversation. I was told every single time that my feelings were a result of my own issues – a manifestation in my head (BULLSHIT).
Gaslighting is a form of manipulation that is so popular among abusers because it’s nearly impossible to identify and it can cause damage that can take years to recover from. With that being said, recovery IS possible.
So for all of us who have fallen victim to the gaslighters in the world, let’s keep on telling each other:
-It isn’t our fault.
-We have done nothing wrong.
-We have nothing to be ashamed of.
-We have every right to be mad as hell.
-We will survive.
-Joy exists on the other side.
–Abusers never win in the end.
What a week! I’m telling ya, PTSD has a way of making you feel like you’re on a rollercoaster and sometimes, you just want to get the heck off! I’ve had some really sad moments this week, and some really happy ones, and then some moments where I have been so angry I can barely think straight.
I acknowledge that I have so many good things going on in my life right now. The support I have received from the podcast and the connections I have been making lately are more valuable to me than I can put into words. When I think about it all, I want to dance and sing and celebrate. And then other moments, like this past weekend, when I finally got to see my newly remodeled office, I started to cry….and then the awful thoughts crept in:
Do I deserve this?
What if I fail?
Will I be taken seriously?
It has been hard to shut these thoughts off lately. And I’ll be the first to admit that I’m not the best at using “coping skills”. In fact, I hate the term “coping skills”. When my mind is racing a mile a minute and when I’m filled with anxiety and doubt, I don’t want to meditate. I don’t want to do deep breathing. I don’t want send thoughts of gratitude out into the universe. Yes, all of these things are wonderful and helpful, but when myself or anyone else is feeling off-the-charts types of emotions, it can be very difficult to get grounded by using the skills listed above. Sometimes, I need something fast and powerful to snap me out of my panic, anger, and shame. I’ve been utilizing a specific DBT-based technique lately that has been helping me tremendously, and I wanted to share it with you.
Yep, I said it. Cold showers. Or if you cannot shower, place ice packs or bags full of cold water on your face, or you can fill up a sink with cold water and dunk your head in!
So let me just back track a little bit. I first learned about taking cold showers as a way to deal with stress, panic, rage, self harm, etc. in 2014. And I immediately rejected it because I am notorious for taking showers so hot that it’s a wonder my flesh has not melted off yet. But a few months back, I rediscovered the effectiveness of temperature change in the body when helping to ground yourself and regulate your nervous system.
I get what you’re probably thinking: “If I’m going to be told that freezing my ass off will help with distress tolerance, I want to know who, what, when, were, why, and how it works. “
So here’s what we know: Humans have something called the “mamalian diving response.” This is an automatic physiological response that occurs in our bodies when we come into contact with cold water. What we know about the mamalian diving response comes from an experiment in 1962 that was done on free divers, which showed that as people dive into colder waters, their heartrates slow down, no matter how vigorous their activity. Some divers were swimming as fast as they could and their heart rate still remained lower in the colder, deeper water. In addition to this, it has been learned that when in colder, deeper water, blood circulation tends to flow away from the limbs and moves instead toward vital organs in the body to protect them and keep them functioning at full capacity.
But here’s the thing, simply dipping your toes in cold water won’t be enough. You need to be all in, well, at least your face. You have trigeminal nerves in your face, which, when in contact with cold water, will send signals to the vagus nerve. The vagus nerve allows for communication between the body and the brain and will cause your heart rate to slow down.
As someone who hates cold showers, I have to say, this technique works!
So when you feel like you can’t turn the intensity level down on your emotions or if you feel like your thoughts won’t stop racing, go try out a cold shower and discover the deep diver in you!
To read more about the mammalian diving response, please click below:
One of the many reasons I love working with kids so much is how blunt they can be. Don’t get me wrong, I also love working with adults, but adults have learned over time to sugar-coat some of what they say, or say things in ways that are not as direct. Kids, on the other hand, just let it out. And I love it. They make me a better therapist, a better human being, and I know they are going to make me a better mom to my own children one day when I start a family…
Yet, as much as I love it, there are some days when my teenagers say something that hits a nerve, as teens are often prone to do!
One of my kiddos really struck a nerve this week (not his fault at all and this is NOT a bad thing). Let’s call him Frankie. Frankie has struggled for years to put words to his feelings. For the first year of therapy, Frankie sat in my office and said very little. He did not appear to have any words to label his feelings, nor did he seem to believe in therapy. Despite giving me only shrugs and nods in response to my questions, he continued to show up week after week, voluntarily. It was a test in my patience to say the least, and let it be known that when it comes to patience, I have very little of it (I’m working on this one)!
But now, two years into therapy, Frankie talks the entire session. He is very aware and observant of the therapist sitting across the room from him, a concept which might easily be taken for granted, but when it comes to developmental trauma, some people have a hard time truly acknowledging another caring, supportive person in the room with them. He has made incredible strides in counseling, and he and I have an awesome therapeutic alliance, which I really cherish.
This week, while talking to Frankie during his session, I attempted to provide some feedback on what he was saying, to which he flatly replied “Umm, nope. No. You’re wrong.” He wasn’t trying to be offensive. He wasn’t trying to do anything except communicate exactly what he verbalized –that I had misinterpreted what he was trying to tell me and I had gotten it all wrong.
This happens in therapy – sometimes we do get it wrong. Most adult patients might have phrased it differently and said something a little less direct, such as “Well, no I don’t think that’s exactly right…” But not Frankie. Frankie was to-the-point, something I know I can always expect from him, and something I truly appreciate about him and most other kids who I see for therapy. But for whatever reason, on this particular day, his response about me being wrong sent me into feelings of shame. I started saying to myself:
“How did I get that wrong? How could I have misinterpreted what he said?”
“What is wrong with me? I’m such a moron.”
“Get your sh** together, Alyssa.”
Figuratively speaking, I beat the crap out of myself. Even as I drove home that night, I felt horrible for being “wrong”, as if being wrong is the equivalent to being “bad”.
This is the shame talking. Shame exacerbates even the most harmless situations until suddenly we feel like crawling in a hole and dying for making a simple, common mistake. Shame makes us feel like we have to be perfectionists, and that anything less than perfection is unacceptable. In believing this, we set ourselves up for failure because we are all human beings, each and every one of us fallible.
Thankfully, I have wrestled with shame and perfectionism long enough in this life to be able to (mostly) push it away when it comes up. I’m much better at talking back to the part of me that feels like making a mistake is the equivalent to being a horrible human being. When I was in the moment with Frankie, I was able to kick the shame and other defenses (i.e. the urge to defend what I was saying) out of my office so I could hold space for him to further explain his point to me. And guess what?
He was correct, and I was indeed wrong!
And that is OKAY! Sometimes we just get it wrong (yes, even therapists!). What’s important is to be able to hold space (whether you’re a therapist or not) to listen to others and acknowledge when you’re wrong without being defensive or letting shame get in the way. We’re all human, and no amount of chastising yourself is going to make you infallible in the future. We do not have the power to be perfect, but we have the power to acknowledge our imperfections, accept them, have compassion for ourselves, and move forward.
Besides, how mundane would life be if we were all perfect?
Thankfully, we’ll never know.