Speak No Evil

The Wednesday night meal at my Intensive Outpatient Program (IOP) was prepared by one of the in-house chefs. Every night of the program, we started eating between 6:30PM and 6:45PM. On Monday nights, “Culinary”, or preparing the meal, was from 5:30PM-6:30PM. On Wednesday nights, we met as a group and discussed how things were going with us in our lives during the 5:30PM-6:30PM timeframe. This session was called “Process”. Just as we have after-meal “processing”, we had other times where we were required to process our feelings, emotions, recovery, goals, etc. While we were having process, the chef was completing the meal. At 6:30PM, we would go into the kitchen.

Because the chef had already prepared the meal, standing in line with our plates was the first time we would see what was on the menu. Again, a sample plate of food along with a sign listing the nutritional exchanges was set out as a guideline. We would go through the buffet just as we had on Monday night and plate our food. The same process of having a Therapeutic Assistant approve your meal was required prior to sitting down with your utensils and glass of water. The timer would be set at 30-minutes and we would start to eat. After our 30-minutes were up, we’d head into our after-meal process group.

The challenges on Tuesday was just as unique as the ones on Monday. For me, it increased as soon as I got into the lobby of the building. Although the treatment center was on the second floor and the kitchen at the far end of an office building, I could smell the food as soon as I walked into the lobby. We were not told in advance what we would be eating during the Monday or Wednesday night meals. Smelling the food down in the lobby, I would become anxious about what was going to be served. Was I going to be in the mood for it or something that I even liked? What ingredients were in it? What was it going to look like? What was the texture and mouthfeel going to be? What were the micro and macronutrients? I would be bombarded with fear and agitation. Fear based on uncertainty and agitation for letting it bother me as well as not having knowledge of what I would be expected to eat. On one occasion, I simply turned around and didn’t show up to treatment because it became too much for me to handle.

For me, Tuesday’s anxiety started hours before treatment began. I wouldn’t even be able to concentrate at work that day from obsessing. By the time we were sitting at the table, I was nearly sick with anxiety. On one Tuesday, a casserole of pasta and chicken topped with cheese was prepared. As was customary with most of us on Tuesday, I forked at the food first, assessing its contents. The sign behind the sample plate may have said “chicken casserole with side salad”. That doesn’t tell me WHAT is in the casserole. On Mondays, I was anxious because I KNEW what was in my food. On Tuesdays, I was anxious because I did NOT know what was in my food. As I forked through the pasta and down through to the bottom of it, I could see the orange-ish substance on my plate- grease. As someone who enjoys cooking at home, I recognized that the cheese on top had released oil as it melted and flowed through the pasta, chicken, and other ingredients. I’ve never been bothered by a visual like this in the past. The more grease, the better. But, that night, I felt sick. I struggled to eat that meal. I tried not looking at it. I tried engaging in the surrounding conversations. I tried not thinking about it. Eventually, I gave into my thoughts and imagined the slimy, greasy, tasteless pasta going down my throat and into my stomach. There was no need in trying to NOT think about it. I was obsessing over it the more I tried NOT to obsess over it.

The process group time was the time for us to be honest with the group as well as ourselves about our feelings surrounding each meal. On the chicken casserole night, I heard over and over again the same feelings that I was having during the meal. It comforted me a bit to hear that I was not completely crazy. As a matter of fact, in this group of people, I was absolutely “normal”. One patient expressed that those ingredients together (the chicken, pasta, and cheese) would normally be a trigger food for her to binge. She said that the discomfort at the meal came from not knowing what those images, tastes, etc. would do later on that night when she was alone. Would she think about it and want to purge the heavy meal? Would it trigger a binge? Would she spend the remainder of the night binging and purging? A few patients said that their anxiety started the moment that they realized that pasta was being served. Pasta was a fear food for a number of people. A couple of people openly said that they were fighting the urges to expel the food because the meal “seemed” so heavy to them. One even said that she wished that our 30-minute after-meal bathroom restriction would hurry up and be over so she could do what she truly wanted to do.

There was one other Tuesday meal that sticks out in my mind because I learned an extremely valuable lesson that evening. That particular Tuesday, “breakfast burritos” were served. Again, we didn’t know what the precise ingredients were. Each ingredient is on the buffet, but doesn’t have a sign to say what it is. Once we were ready to eat, we all started the forking- at- the –food process. There were four other patients sitting at my table that night and they were all doing the exact same thing and looking as baffled as I was. I quietly mumbled, out loud, “What is this?”. There was a sigh of relief and all four of them smiled at me. It seemed like someone had lifted a burden off of us. The five of us whispered about the mysterious meal and the four of them started to quietly give hints of their experiences at other treatment facilities.

In process, I would find out that nobody had an idea what was in those burritos either. Our best guess was that it was either ground chicken, ground sausage, scrambled eggs, or some odd hybrid of ingredients. Even the TAs never confirmed what the filling was. Imagine the anxiety we all felt during and after that meal. We all were required to eat something that we had NO idea what it was. If there is anxiety at facing identifiable food, imagine the anxiety at eating something that you have no idea what to even be anxious about. We were left anxious over whether to worry about tortillas and eggs or tortillas and meat. It may not seem significant, but there can easily be a different level of worry for some between those two different meals.

I had no idea that my anxiety was about to go sky-high during Process. At the end of that process group, one of the TAs sternly advised us that we were to NOT discuss the meal during the meal. WHAT?!?!?! Yes. We were not allowed to ever talk about the food while we were eating the food. That sort of conversation was what Meal Process was for. This was totally new to me. Talking about the food, saying that you enjoy it or not, asking questions about the content, telling stories about other events relating to food, are all part of normal mealtime conversation to me. When I said “What is this?” I was innocently doing what comes naturally and comfortably to me- talking about the food. The TA didn’t single me out, but everyone at my table knew that I had started that conversation. The TA had heard us and perhaps others at the other tables had too. I felt guilt, shame, and anger. Nobody had given me a “Treatment 101” book that told me what was acceptable or not to say or do in treatment. I didn’t want to be the “bad” guy and cause anyone else pain. I didn’t want to be the “rebel” and break the rules.

I soon came to realize that people have different triggers that may not be obvious to others. Those that had been through treatment programs before (everyone except me and one other woman), knew this. When I brought up the looks and curiousness of the food at the dinner table, it could have triggered someone to start obsessing over it, causing them not to eat. My actions could have caused someone who would have powered through that meal and successfully met their eating requirement to not eat at all. Maybe they would so respect my opinion that if I had a problem with the food, they should have a problem with it as well. Maybe they wouldn’t have noticed anything odd about the food until they heard me mention it. There are infinite ways that every individual human differently processes things. I had never thought about it that way. I’ve started to notice, now, how I feel about the things that I eat. I recently had someone say that something that I enjoy eating was “nasty”. I felt shame and as if something was “wrong” with me. To me, if I eat food that is considered unpleasant, doesn’t that mean that I, myself, am unpleasant, particularly to that person? I had that feeling for but a moment. But, it truly does show how powerful our words and actions can be.