Human Up Season 1 Ep 6: Insights on Eating Disorders and Recovery

This is a transcript of Human Up Podcast Season 1, Episode 6 with Mary Elizabeth Sanchez, which you can watch and listen to here:

Dave Marlon: Welcome to the Human Up Podcast. I'm Dave Marlon and I'm honored to be joined by Mary Elizabeth Sanchez, who is an eating disorder advocate, a crisis counselor and one of the amazing clinicians here at Vegas Strong. She received her BA in psychology from Aurora University in Illinois, and her master's in clinical and counseling psychology from Benedictine University in Illinois. She's worked with community-based healthcare centers and crisis centers all over the United States, including the domestic violence shelter, safe Nest here in Las Vegas. She's been working at Vegas Stronger facilitating our intensive outpatient program, mental health group, and most recently working with the felony DUI treatment courts and the veterans court programs. She's a part, a passion for working with the eating disorder community and has her own experience with eating disorders as well as treatment. Welcome, Mary.

Mary Sanchez: Hi Dave. Thank you so much for having me. I'm excited to be here.

Dave: Yeah, I'm excited you're here as well and I'm honored to be able to work with you every day, especially lately. You've certainly gotten into your jam here and I know you're seeing and developing great rapport with lots of clients.

Mary:

Yes, I am. Yes, I am, and I love what I do at Vegas stronger, and I feel like there's a lot of potential for growth here. So like I said, you're stuck with me.

Dave: Oh no, I'm thrilled about that. It's funny you talk about growth and it reminds me of I had this time I went with my son when I was in my early rehab days and we walked out to go pray and we're walking back. My son said, dad, what you pray for? And I said, I prayed to grow and I hope I prayed for more clients.

And

My son looked up at me and he said, oh, that's cool, dad. And I looked down at him and I said, what did you pray for? And he said, dad, I prayed for the clients that you have, and it hit me to the core out of the mouth of babes. I love the fact that we're growing, but I also, I love the fact that there's hundreds of people here coming to your group, seeing you individually and having you help them address their various issues.

Mary: Yes, yes. It's a passion of mine and I wake up every day excited to do what I get to do, and it's not so much that I, I've changed my perspective from have to get to because of an absolute blessing that I'm able to do what I'm passionate about every single day

Dave: And it shows because you're very good at it.

Mary: Thank you, I appreciate that.

Dave: Now, you mentioned that you grew to love psychology early on in your life.

Mary: Yes, I did.

Dave: Can you tell me what drew you to psychology and how you became a clinician?

Mary: Yeah, so I took an intro to psych class in high school, and that's really what sparked it. That was my senior year of high school and before that I thought I was dead set on becoming a nurse. And when I took that class, my perspective changed. While I was in that class, my younger brother went through some depression and a lot of psychological ailments of his own. He had to go into treatment and visiting him at the treatment center was just so, it was a profound experience for me. It really showed me that I need to get into this field. And so after high school I went into Aurora University and declared my major as psychology, and it just took off from there. And a little nerd fact of mind, I graduated cum laude honors from my undergraduate and summa cum laude honors from my graduate program. So I really took it seriously and it didn't feel like I was in school because I was so passionate about what I was learning.

Dave: That's awesome. That does not surprise me, and that's cool. So it was in seeing your brother being able to receive treatment that works, that is effective, that inspired you?

Mary: Yes, and he's doing great now. He's got, he's married, he's got a young daughter and he's just really thriving and excelling in life. And another thing that brought me into this field was battling my own eating disorder and knowing that I didn't want what I went through to go in vain. And so I wanted to use that to help other people that have been marginalized, that have struggled with addiction and help them see that treatment is available and recovery is possible.

Dave: That's awesome. Tell me, what's an eating disorder?

Mary: So in eating disorder, there are various types of an eating disorder. The ones that people commonly know about are anorexia nervosa and bulimia nervosa. Anorexia nervosa is when you starve yourself and or limit the intake of food that you take in. And then bulimia nervosa is when you purge the food that you've eaten, whether it's through vomiting, whether through laxative, abuse, exercise abuse, and these two disorders are commonly seen in conjunction with one another. So individuals can be diagnosed with anorexia nervosa, restrictive type, which is where they restrict their intake of food or anorexia nervosa, purging type, which is when they eat, but then they throw it up, they exercise or they abuse laxatives to get rid of it. Then there's also binge eating disorder, which has gotten a lot more recognition in more recent years, and it's becoming more researched and more studied, which I think is great because the treatment aspects of what helps anorexia and bulimia is different from what helps binge eating disorder.

Dave: It's interesting, whenever I've studied mental health disorders, I always self-identify with all of them, and I certainly binge ate. I certainly ate so much that I wanted to make myself vomit. I certainly, I had to suck weight as a wrestler and I have to

Mary: Suck

Dave: Weight as a fighter, I certainly limit my food intake. How do I know if I have a disorder

Mary: When it starts impacting areas of your life? So when you become so fearful of food that you're not willing to take anything in when every meal after every meal, you're vomiting or you have to get rid of it, and it's inside your mind too because you hear this internal voice telling you that you're fat, you're lazy, you're ugly. If you were this size, you would be happy. You have to be a size zero to be beautiful. So it really becomes that inner dialogue and it's strong to the point where that your own voice is not being heard anymore. It's the eating disorder voice that's overpowering everything.

Dave: Wow. You talked about being a size zero. So is this mostly a females issue?

Mary: So primarily individuals. Statistically it's white, middle class females that struggle with eating disorders, but you do see it among men, especially when you get into the aspects of wrestling, gymnastics, horse jockeys can also develop this because you have to make a certain weight.

Yeah, you

Got to little, yeah, you have to be a certain size to do these activities, and so men can definitely develop eating disorders. It's not just a woman's disorder. Primarily it's seen in women, but I think that if more men came forward with it during research studies and were willing to say, Hey, I do struggle with that, then we would see a lot more prevalence in males.

Dave: That's interesting. You talked about this voice inside you, which drew a correlation to me when I used to have a voice inside of me saying, let's go drink with my substance use disorder. To my knowledge, I've never struggled with an eating disorder, but I certainly identify with that voice inside.

Mary: Oh, absolutely. And it's similar to that voice that you get when you struggle with a substance use disorder. It's almost, I like to compare it to the devil and the angel. The angel is telling you, eat, you need it, you need to be nourished. But then that devil is like, no, you'll get fat, you'll be ugly. And so that devil eventually gets so strong that that's all you're listening to.

Dave: While you were talking about, oh, I'll be fat or I'm not ugly, I wonder, does body dysmorphia cross into this as well? Sometimes?

Mary: Very much so, yes. So when I was in treatment and I was putting on that weight that I needed to get to a healthy weight, my body image of myself, we did this activity where we laid on the ground or we laid above a huge piece of paper and we drew what we thought our body looked like, and then we laid within that outline. And the difference between what I thought I looked like and what I actually was, was undescribable. I mean, it was a tremendous difference about how my body image of myself looked as compared to when somebody traced me what the actual size was. So body dysmorphia definitely plays a role in eating disorders.

Dave: That's interesting. How do you recover from that body dysmorphia from that voice? How do you recover from

Mary: That? So a lot of treatment, I went into treatment. I took my freshman year, I took the second of college, I took the second semester off and I entered treatment. And treatment like with substance use disorders is very structured. You've got a schedule of eating, so you'll wake up for breakfast, you'll eat at eight, you'll have a snack at 10 30. You'll have lunch at 12, snack at two 30, dinner at five, snack at eight 30. But aside from just the eating component, you have a lot of therapy that you have to go through, whether it's group and primarily individual therapy because you have to strengthen that healthy voice inside of you. And you can't do it a lot of the time. You can't do it on your own. And so you need that help. And so I am so grateful that we have centers that are specializing in eating disorder treatment. It can be very tricky.

Dave: Wow, that's fascinating. And boy, lots of parallels how in substance use treatment, it takes time, it takes structure, it takes a therapeutic connection, and in general, people don't recover on their own. It takes somebody outside to be able to correct those false narratives.

Mary: Right, exactly. And whether that's through group therapy, individual therapy, a combination of both, it really takes treatment to get you to a place not only weight stable, but to get your mental health back and to start disproving those negative thoughts and that negative image that you have of yourself.

Dave: Well, that's really fascinating. When it comes to eating disorders, what's something that's lacking in public awareness?

Mary: Public awareness. I think we need to talk about it more first and foremost. I think that the more we talk about it, the more it can become, people will become aware of it. We see a lot of education and a lot of awareness being brought up about substance use disorders, but not so much eating disorders. And they are very real. They're very prevalent. And another thing I think that we need is more treatment. I mean, we need more treatment because that's the way that people are going to get help. When I lived in the Chicago area between Chicago area and Wisconsin, there were probably eight or nine treatment facilities that specialized in eating disorders, which is great for that area in Vegas. I know I think of two that specialized in eating disorder treatment, inpatient, partial, IOP, that. And so I think with more treatment can become more awareness, and I think people have to feel safe talking about it. It's not that if you talk about an eating, if you talk about eating disorders, you're not just going to develop an eating disorder. That's not how it works.

Dave: But

Mary: I think with more awareness and more education, people will feel more comfortable and safe coming forward saying, I too struggle with this. I need help.

Dave: Interesting. Well, I'm glad we are talking about it. It's one of the first steps. So thank you very much for being on this podcast. Yes. In my years of treating people with substance use disorders, I have had several females which were at dangerous body weights. They got into the seventies and eighties, and it was like hospitalization and IV and intubation. Now that seems pretty extreme. What are some other signs and symptoms of an eating disorder?

Mary: So anybody that's looking severely emaciated, if somebody goes to the bathroom every time after they eat, if they're working out, there's a healthy balance. You go to the gym for a few days a week for a few hours, that's okay. But if you go to the gym every single day and you're there for four or five hours, what's going on there? Or if you notice a stockpile of laxatives, are they abusing laxatives? If they're preoccupied with the number on the scale, that can be another indication that an individual could be struggling with an eating disorder, body image disorder and everything combined. And I've also seen a lot of the time when individuals struggle with eating disorders, a lot of the time they do have a substance use disorder with it as

Dave: Well. Yeah, I guess having used methamphetamine in my early life, I recognize that if you use it, I mean, I don't have to eat that whole day.

Mary: Exactly. Correct. And the stimulant, and not just methamphetamine or cocaine, but one of the big things now that people are abusing is Adderall or Vyvanse. So you take one of those and you don't feel hungry. And so it's stimulating that eating disorder. It's making that eating disorder stronger.

Dave: Interesting. I've also seen clients who had bulimia and it ended up showing up because they had dental problems.

Mary: Oh, absolutely. Yes. And personally, I'm not afraid to share this because I'm very strong in my recovery today. My bulimia actually caused me to lose my top teeth. And so that is a sign that someone could be struggling with bulimia, and that is how bad it can get. It can cause severe dental issues and they can be managed through dental care. But yeah, your teeth definitely take a beating when you struggle with bulemia.

Dave: So is that the acid from the stomach

Mary: Coming

Dave: Up and causing, so you must've been purging often

Mary: Every day, multiple times a day? Yes, yes. At the depths of my disease, I was very sick. Yeah.

Dave: How long did that go on?

Mary: My eating disorder developed when I was 17 years old, and then I went into treatment when I was about 18, and then I had a very long frame of stable recovery, and then I relapsed, and then I got back into what was working for me. And one of the programs that I found that has saved my life is Overeaters Anonymous.

So yeah, it's mirrored just like AA or na, but we changed the word alcoholic to food addict or anorexic or bulimic, and we changed the word alcoholism to food addiction. It's very similar. Everything's the same, the steps are the same. But once I found that program, I was able to flourish in my recovery and I worked with a sponsor. I had to make sure that I was eating a meal plan, was designed by a registered dietician. And with that program, my life changed dramatically. And I am happy to say that my lowest weight when my eating disorder was at its worst was 79 pounds. And I, I'm five seven, but now I'm at a healthy 135 pounds, and I've been maintaining it for about four years now, and I feel great.

Dave: Oh, good. Oh, what a testimony of that treatment works.

It does.

And it's interesting. I love the fact that you talked about this voice in our head, call it the devil or what have you, that unhealthy voice that becomes part of our consciousness that isn't helping us. And in my experience, it takes 90, 180 even more time to kind of change the neural pathway linked to one of those voices to be able to effectuate lasting change. But it does

Mary: Work. Absolutely. It does. It does. And that voice still creeps in every now and then. But the healthy voice within me is stronger now to say, Nope, go away. I'm not returning to my eating disorder behaviors. I'm doing good. And I don't want to go back to the struggling with that disease. And so treatment isn't going to look the same for everybody. Traditional treatment helped me, but what really saved my life and put myself and put my life on the right path was the 12 steps of Overeaters Anonymous.

Dave: Oh, that's beautiful. It's funny, I was in San Diego this weekend and right off of PCH, it was a giant billboard for Overeaters Anonymous.

Mary: Oh, that's great.

Dave: And I looked up and I saw that, and I was like, you don't see that every day.

Mary: No, you don't. But I love that there's awareness and that shows that people have somewhere to go, and the name can be a little deceiving. It says Overeaters Anonymous, but those rooms, they're filled with anorexics. They're filled with bulimics, they're filled with people that struggle with food. And it's really a place that you go. You connect with people that know your struggle. You work with a sponsor and you really connect with a higher power. And that is what for me, that's what helped me to find lasting recovery.

Dave: Same, by the way, but mine with a substance use disorder. So I'm with you. Wow, that's amazing. It's interesting to me. There's kind of a bell curve and on one end of the bell curve is inadequate or not eating enough, But there's another end of the bell curve, and it seems to be even a more prevalent problem with obesity with people who eat too much.

Mary: Is

Dave: The treatment the same for that? How does the larger end of the bell curve get addressed?

Mary: Yeah, so treatment's going to be different. When you go into treatment as somebody that's restricting their food, they're going to make you eat. They are going, that's basically what your day is scheduled around. When you go in for binge eating disorder, they're going to tailor your meal plan to help you lose weight in a healthy way. And so treatment, you have to find specific treatments for binge eating disorders. And there are specialists out there. There are eating disorder treatment facilities that do specialize in that, but the treatment's not cookie cutter, right? It's got to be individualized to the person. And so if somebody is going in for binge eating disorder, they're going to be working with a nutritionist from a different angle than an anorexic would. But treatment is effective and it does work. And then I'm not going to get too much into the pharmaceutical side of treatment because that's not in my line of treatment of line of specialty, but there are medications that can help and that do show lasting effects for treatment and recovery of these disorders.

Dave: Now, again, I imagine there's different medications or different pharmacological interventions on either end. There's a big fad with this glide for binge eating to slow your digestive process, and that seems to be widely adopted, and it does appear to be effective. I'm not sure if it's lasting, but I know many people who are happy that they've lost some weight using this medication. What do you think about the medication response?

Mary: I think it's a great place to start, but I think for lasting change, it has to be a lifestyle change. It really has to be something that you're going to commit to and for the life of you. And like you said, I don't know if that medication that everybody has adopted is safe for long-term use, because I don't know if we have that research yet, but I think that it's a great place to start. And if that can help you to get into recovery, then that's great because everybody's story of getting into recovery is going to be different. It's not going to be just going to the traditional treatment center, or it could be walking into oa. It can be just being around the right people. So it really is, again, it's very individualized to what the person needs.

Dave: Well, the parallels are amazing. I feel the same way that with substance use disorders, I have people come in and say, I've been using fentanyl. I need to get on methadone, or I need to be on buprenorphine. And they think that's the panacea. Not acknowledging that this voice in their conscious or subconscious that is the problem that actually gets addressed in treatment. So these pharmacological tools help, but they work way more effective when it's paired with a counseling intervention.

Absolutely.

Sounds like it's the same for eating disorders as well as substance use disorders.

Mary: Absolutely. And I look at treatment as a puzzle, right? A puzzle has many different components and many different pieces that go into it, and we have to put together the appropriate puzzle pieces for that client to put their puzzle together. So whether that's individual therapy, group therapy, pharmaceuticals, spiritual health is very important, feeling connected to others. So everybody's puzzle is going to be different, but there are components that are going to be similar throughout.

Dave: Awesome. Wow. All right. Good stuff. All right. Let me change gears. You've been helping a lot of unhoused clients at Vegas Strong running the mental health group for a little while.

Mary: Yes.

Dave: How was that different from previous work in your career?

Mary: So in previous work, I was never working with individuals that were homeless, that were coming into treatment that had nothing. And so this really opened my eyes to not only being able to help them, but of how big of a pandemic homelessness is in our country and especially in Las Vegas. And so being able to be on the forefront of that, helping 'em get in to get an assessment, helping them to get housed, being part of that, I just got the Chills, has been a great experience for me and humbling as well, because I think that in the work that we do, sometimes we can get caught up in the day to day, but when we sit down and we actually realize, wow, I helped that person get housed today, that really makes you feel good. But it also makes me appreciate what I have and what blessings that I've been blessed with in life. But running that mental health group gave me a wealth of knowledge that I don't think I would've gotten anywhere else. So it was definitely time well spent. I can say,

Dave: Yeah, I've always been impressed with, because I sat in your mental health group a few times and I saw many of the clients, many of which were right on the cusp from I thought needing lifetime institutionalization. I mean, these were chronic, seriously impaired, seriously mentally ill folks. And seeing them get stable on a pharmacological regimen and then see 'em do your IOP for weeks and then months, I was shocked seeing how high functioning many of them became. And going from hopeless to housed, employed, I kind of get chills myself. That was that group in particular, seeing the clients as they come in and then seeing them six months later, it's such stark improvements is usually the case. Really encouraging.

Mary: Absolutely. And I think too, what really does it is it's a place for them to be heard. It's a place for them to be seen. And a lot of the time, the biggest predictor of successful treatment is the ability to connect with a therapist, with a group facilitator, someone they feel safe with so that they have a place to go that they can feel that they're seen and heard. And I think that when you have that component, when you feel connected, then it just motivates you to keep going back. And then when you keep going back, you start making that progress that we see in many of our mental health individuals.

Dave: I agree with you. And something that I struggle with is when to utilize self-disclosure when I'm engaged in group or individual treatment. Do you struggle with that?

Mary: I do. And when I was in graduate school, we were taught you one great principle. If it will benefit your client's treatment, then it's okay to self-disclose self-disclose your entire story. But if they're struggling with something and you've struggled with something similar, it's okay to self-disclose if it's going to benefit their treatment.

Dave: I did a really interesting experience during my practicum. I did one year at Salvation Army and I did one year at community counseling. These are two community places. And when I went to Salvation Army, I worked there for a year and I never told anyone I was in recovery.

I never self disclosed. And I made a conscious effort to do that. And then when I went to community counseling, I was open about it whenever it came up, and I did some limited self-disclosure. And my experience was it didn't change anything. It was just my shit.

Mary: It was right. And sometimes when they hear that we've gone through similar challenges, that gives them hope. Other times they're like, okay, well back to me. So it can go either way. Right.

Agreed. You should tread that line very lightly and very carefully. But I think that as a therapist, there's a time and place to self-disclose only if it will benefit your client's treatment

Dave: Textbook. Right on. Agreed. So what's something that's lacking in public perception that when it comes to homelessness based on what you're seeing at Vegas stronger?

Mary: I think what's lacking in public perception is that a lot of people think that if they're homeless, they're automatically addicted to substances or if they're homeless, they want to be that way. And that's not the case. And so I think that more education and more awareness needs to be shown that a lot of these individuals didn't ask to be in this situation. And many of these individuals are not addicted to substances. They're just in a really tight spot or a really difficult spot at this time. And so I think if we can get the public's perspective to change, I think we'll see a lot more positive growth in the direction of housing our homeless community and getting 'em the resources that they deserve.

Dave: Awesome. Agreed. And again, just like I'm glad we're creating some awareness by talking about eating disorders. I appreciate you and me talking about homelessness and how serious of a crisis it is in our community,

Mary: Right? Absolutely. Absolutely. And I was just at a training Monday and Tuesday, and we learned that a very large percentage of the homeless population are US veterans. And that just breaks my heart knowing that they fought for our country. And I believe that we should make sure that not only they are housed, but the rest of our homeless community are housed as well.

Dave: Agreed. And I a hundred percent agree first them or with a heightened order of importance, our veterans, they didn't deserve the best care

Available. Absolutely. Absolutely.

The title of our podcast is Human Up.

Mary: Yes.

Dave: Can you tell me what does that mean to you?

Mary: So human Up means to me, trying to be better today than you were yesterday. Trying to get to that place and go in the direction that you see for yourself if your ultimate goals and what that looks like. Again, everybody's going to be individualized, but for me, it's always my goal to be better today than I was yesterday.

Dave: Human up. That's awesome.

Mary: Absolutely.

Dave: Is there anything else we should talk about before we wrap up?

Mary: I think that we've touched all the important ideas and topics that we needed to touch today, but one thing I will put in your ear is maybe starting an eating disorder group at Vegas Stronger.

Dave: I certainly support if there's a need. Most importantly, Mary, thank you so much for being on the podcast, and thank you so much for helping so many of our clients with your group and your individual work. I appreciate you and thank you for being on Human Up.

Mary: Thank you so much. It's been an honor, and I'm looking forward to working with you for many days to come.

Dave: Right on. Likewise. Thanks, Mary.

Mary: You're welcome.