Approach ‘13 Reasons Why’ with Curiosity Instead of Fear

By Lindsay Merrell, Therapist, Remuda Ranch at The Meadows

Since the years of my internship, working with patients facing suicidal thoughts has been concerning, challenging, and inspiring. Individuals struggling with such hopelessness come to professionals in desperate need of relief from what is starting to feel like an inevitable outcome. Our responsibility as professionals is to be persistently and empathically interested in the individual’s struggle. Our curiosity gives them the courage to look at the very pain they fear.

Netflix’s hit TV Show 13 Reasons Why provides the audience with a window into the multitude of opportunities a community often has to intervene when an individual is living in fear of their pain.

In 13 Reasons Why, the main character, Hannah, struggles with suicidal thoughts. She risks reaching out to her guidance counselor—the very person tasked with being a support to adolescence in the educational environment-- for help; but, as a result, we as an audience witness the harm that occurs when helping professionals lack curiosity.

The guidance counselor dismisses Hannah’s pain and a disconnection from help occurred. The show portrays very well how the disconnection from compassionate support leads to an increase in isolation and stigma for the individual and for the community as it experiences a traumatic event.
Adolescents are already at an anatomical disadvantage when it comes to seeking support. They are experiencing normal, but tumultuous hormonal changes within a neurological system that hasn’t yet developed insight into cognitive distortions or the ability to restructure distorted thoughts. As professionals, we have the opportunity to assist and educate individuals and families on how to navigate the ups and downs of the adolescent years; however, this opportunity often only comes after worrisome symptoms appear.

13 Reasons Why has given teenagers, schools, and families a framework from which to process situations which may already be occurring right under their noses, and will hopefully give them the chance to intervene before the individual’s desperation takes over.

Recently, the media has reported that many parents, teachers, and counselors are concerned that 13 Reasons Why “glorifies” suicide. But, it seems to me that 13 Reasons Why could bring about more awareness on how to support an individual struggling with suicidal thoughts or how those who are struggling with suicidal thoughts can seek support.

As friends, therapists, and parents, aren't we better equipped to help when we are more culturally aware and curious about the nuances individuals’ struggles? It seems unreasonable to make a judgment about the “dangers” of the show simply based on the fact that the characters in the storyline do not handle the situations in the one size fits all manner we deem best.

Before her tragic death, Hannah records a series of tapes to illustrate how ignorance, fear, and judgment disconnected her, and disconnects others, from necessary interventions and support within the community. Through the lens of fear, Hannah's tapes may appear to assign blame to everyone involved; however, when fear is replaced with curiosity and empathy, can’t the tapes be viewed as an educational opportunity for the viewer? The tapes teach us that asking questions, paying attention, and speaking up can provide hope for recovery from what feels like insurmountable pain.

Fear of judgment from peers and adults coupled with the stigma around asking for support unnecessarily leads adolescents to suppress their perceived realities to struggle through it alone more than they have to. This often leads to the manifestation of eating disorders, substance abuse, self-harm, and suicidal ideation. The challenge for the individual and the community portrayed in the show is the suppression of the struggling individual’s perceived reality and the ultimate lack of awareness of the real pain of that struggle.

Compassion’s enemy is fear. It paralyzes people and prevents them from helping those who struggle with suicidal ideation. Let’s not allow ourselves to be paralyzed by the fear of what 13 Reasons Why could teach young people; instead, let use it to teach ourselves how to be more compassionate, how to best offer the support that is needed, and how to stay curious and ask questions that can help lead those suffering to peace.

13 Reasons Why is a show that illuminates the difficulties adolescents face. As adults, when we put our fear aside and become curious, we open the door to protecting a vulnerable individual from a life-altering decision and breathe hope back into those we care about.

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A Letter To My Younger Self

To my former, wonderful self:
I know you’re hurting right now beautiful girl. I promise, it’s going to be okay. You’re feeling so out of control. All of your thoughts are racing in circles believing that the professionals surrounding you in these moments just want you to stay fat forever.

They want you to let them down; your grandparents, your parents, your classmates. Those are the ones that you thought if you lost all that weight, then they’d be proud of you. Maxie, they’re already proud of you and love you for being the kindest and most loving little girl in the world. I know it’s taking all of your strength to not give up and continue to listen to the voice of your eating disorder.

You hate your reflection and that all these doctors and nurses are forcing you to eat. You don’t understand it and can’t even begin to look at this situation from a positive perspective without hearing the voices of your grandparents lingering in the back of your mind every moment of the day. I’m so sorry that they let you down; that mom and dad didn’t stand up for you and say that those words weren’t true. I’m here to tell you sweetheart, that you don’t need to be worrying about how small your jean size is or how much the number on the scale says when it stares back at you as you nervously await its reading.

You are and will forever be perfectly imperfect and beautiful just the way you are no matter what your outside appearance looks like. Those cruel words they said calling you fat and demanding you to lose weight were all lies. They made you believe a vision of yourself that isn’t true. I’m so sorry for all the pain that they’ve caused you. I know you’re hurting right now. I promise, it’s going to be okay.

You don’t need to starve yourself to feel accepted into this world. You don’t need to deprive yourself of social outings with friends just because you’re so afraid they’re going to offer you something to eat. Go out and have fun every time you get the opportunity to. You deserve it.

You are so smart Maxie and so loving; this world is lucky to have you in it. Please don’t allow the voice of this disorder continue to allow you to think any differently. With your infectious spirit and personality, you touch the lives of every single person that you meet. Your smile, it lights up the room. Please remember this the next time you want to skip your breakfast or your afternoon snack.

You are so worthy of living a full life outside of this darkness called Anorexia and I need you to believe this. Your Grandpa Bob needs you to believe this. He thinks you’re brilliant and that you deserve to be the happiest girl in the entire world. Although he will leave your life too soon, he will be here long enough to make you a stronger person and help you fight those ED thoughts. Through his infinite presence in your life, you will keep fighting for the life you so desperately want for yourself and he will forever be proud of you.

The future is going to be so bright for you, beautiful girl. You’re going to meet an amazing man that’s going to love you unconditionally for a period of time in your high school years. He’s going to help you stop self-harming every day and eat delicious food without guilt afterwards. You are worthy of that kind of love.
Soon, you’re going to have so much energy that you’ll be able to run outside and go to the gym and lift heavy weights without any difficulty because you’ll be feeding your body the nutrition it needs. You’ll get to a point where you’ll run and exercise, not out of self-hatred, but out of self-love. You will care so much for yourself and the life you live more than anyone, including yourself ever has before.

You don’t need to harm your left arm anymore. There is nothing wrong with you, sweet girl. There is no need to punish yourself for being strong and consuming that mint chocolate chip ice cream or Reeses candy bar you deprived yourself of for so long. You deserve every bite and I hope you enjoy more of those.

Please listen to your therapist and let those wounds heal. I know you’re hurting right now. I promise, it’s going to be okay. Those scars will be reminders of every battle you fought and won; and every battle you’ll continue to fight and win for years to come. Although there will be more challenges awaiting you in the future, the victories that come with surviving this disorder will make it all worth it. I believe in you, beautiful girl.

You can silence the voices of your grandparents that remain a constant in your head and create new ones. Ones that describe the real Maxie. The Maxie that is worthy of love, kindness, and care to herself. I just want to let you know, that even at the young age of 11 years old, you are strong beyond measure and have the will to keep going. A life of joy, body positivity, and acceptance of yourself awaits you on the other side where full recovery lives on and I’ll be right here rooting for you once you get there.

I’ll love you always and forever,
Maxie

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Diabulimia: Abusing Insulin to Lose Weight

Type I diabetes and an eating disorder can be the worst possible combination. While most people with bulimia purge through vomiting or excessive exercise; someone with diabulimia purges by under-dosing insulin, which causes sugar to be eliminated from her body through urine reducing their caloric intake.

In the last 10 years, this dangerous new trend of manipulating insulin doses to lose weight has emerged among women with diabetes and eating disorders. Several studies have come to the conclusion that women with type 1 diabetes are twice as likely to be diagnosed with an eating disorder as their non-diabetic peers. (Although diabulimia is more common among women, men with type1 diabetes can and do struggle with it as well.)

Living with type 1 diabetes is not easy. Sometimes insulin manipulation and other behaviors that indicate the person is struggling with an eating disorder start out as small acts of rebellion, but can escalate over time into an overwhelming cycle of eating disordered thoughts and symptoms.

For some people, the necessary emphasis on food and dietary restraint associated with the management of type 1 diabetes can create an unhealthy focus on food, numbers, and control. The psychological and emotional effects of having to manage a chronic medical condition such as type 1 diabetes can also play a role in developing the dual diagnosis of an eating disorder. Depression, anxiety and poor body image are also common co-occurring conditions.

The Dangers of Manipulating Insulin Dosages

Manipulating insulin dosages isn't healthy and can be deadly. When an eating disorder accompanies type 1 diabetes, the mortality rate climbs to nearly 35 percent.

In addition to the increased risk of death, there is also an increase in the escalation of medical complications from diabetes such as vision loss and kidney failure. The health issues that a diabetic might typically expect to experience in 30 years can begin to occur within five or seven years if she is abusing insulin and exhibiting disordered eating behaviors.

For example, if a type I diabetic begins insulin manipulation at the age of 17, she could become totally blind, begin suffering from extreme nerve pain or need to be on a kidney transplant list by her mid-20s. Her ability to have children may be permanently compromised as well.

Signs of Insulin Abuse

If you are a parent, spouse, or family member of a diabetic, and you think believe she may be manipulating her insulin dosages to lose or maintain her body weight, it’s important to take action. The earlier you get seek help, the greater the possibility for a positive outcome. Here are some of the signs of insulin abuse:

• The person seems dehydrated, tired and irritable.
• The person’s insulin supply seems to be lasting them longer than expected. They purchase fewer bottles than usual.
• The blood sugar log on their glucometer shows that they have not been maintaining healthy levels.
• You might also encourage your loved one to go to their doctor for a Hemoglobin A1C test.

Share your concerns about their possible eating disorder with the doctor, if you can.

Get Help for Diabulimia

The complications from diabulimia and other disordered behaviors are very serious. Those who struggle with type 1 diabetes along with anorexia or bulimia can experience recovery with the right medical and psychological interventions. At Remuda Ranch at The Meadows, our expert team of doctors and therapists can develop a personalized inpatient treatment program to help women and adolescent girls learn to control their diabetes while recovering from an eating disorder. We also offer the Remuda Ranch Eating Recovery Intensive Outpatient Program for both men and women at The Meadows Outpatient Center. Call today for more information: 866-332-7381.

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A Letter To Myself

Dear Jan at 45 I am the 62 old you writing to encourage and give you the hope that you desperately need. I know your pain. You believe incorrectly that after purging every day for 25 years and now starving yourself that your life is hopeless - I know what you are praying for – A normal life - Not that you know what that is but you would sure like to have it. I am here to tell you that your life ahead will not be normal. It will be so much better than that. It will be amazing.

You are strong – you just haven’t realized that yet - I know the women you will become because I am her. You will work hard with the tools you learned at Remuda but you will fall sometimes. Don’t beat yourself up - Keep on trying – never giving up. As you practice the tools you learned at Remuda and trust the Lord and ask for his help you will make it. Little by little eating disorders will be a thing of the past. I promise you that the Lord will take away all your eating disorder thoughts and they will never be a part of you again.

You will marry a man who will love you with all his heart and call you his special angel. You are beautiful in his eyes. You will blossom and love yourself for the women you are becoming – a daughter of God. You will be an instrument in helping and encouraging others trapped in addictions. You will volunteer in the jail and act as a facilitator for a 12-step addiction recovery program. As you work the program repeatedly with the inmates you will grow stronger and stronger in your own recovery. You will inspire these women and change many of their lives as you love and nourish them with hope.

You will take care of your body always nourishing it with healthy food and exercise. You will weigh what you should and never count calories or have a desire to be anything than what you already are.

Your dreams will come true. You will live in Hawaii in a little yellow beach house by the beach. You have joy in your life as you love and serve other.
Now my dear Jan – My advice to you is to listen to your doctors and your counselors. They know what they are doing. Don’t let your fears destroy you. Work on your recovery. It is hard but it is worth it. Say daily affirmations – at first you won’t believe it but gradually they will become a part of you. Don’t let the number on the scale be the basis for your self-worth. You are much more than a number. Say positive things about yourself – NEVER putting yourself down. Have healthy boundaries and most important – Do not hurt yourself. Please Jan, don’t give up now - You will do it - I love you – Please don’t let us die.

Love,
Jan at 62

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What I Would Say To My Former Self

You do not have to run anymore. You don’t need to be ashamed or afraid. You are finding your voice and discovering that you are more than enough. You DESERVE to be loved, appreciated and accepted. 

 

Your voice, your body, your thoughts, your MISTAKES, your presence, your worries, your ideas and opinions are all valuable. Do not give up for your smile lights so many faces and reaches beyond the stars. At the Ranch it was more than skills it was a form of acceptance I never knew. That acceptance opened a door that allowed me to nourish my body and realize what I had long learned to forget and grossly undervalue.

 

I am worthy. I can and am doing more than the greatness I ever imagined. I am strong. No achievement has or ever will be greater than realizing I am enough. I do not have to starve or rid my body of anything. I do not need to be thin, thick or pretty. You can find yourself again. One step at a time. DON’T ever let anyone (including yourself) tell you otherwise. You are courageous, strong, smart, beautiful and valuable. You are the star that continues to glow.

Sincerely,
Morgan Pope

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