My plan to challenge myself over the weekend went reasonably well. I couldn’t cope with the thought of eating a burger, so I chose a smoked salmon bagel with spicy cream cheese, peppers, and onion instead. In calorific terms it was almost the same as the burger. For pudding I had a hot cinnamon roll. It was one of the best things I’ve tasted in months. And I successfully cut my exercise by almost half.
Today I went to the doctor’s surgery and weighed myself on the big scale there. It wasn’t done out of eating disordered urges. (For that I would have gone to Boots and weighed myself furtively, not walked in to the doctor’s and politely asked the receptionist if I could note my weight.) I wanted to make sure that I was keeping stable.
Since I stopped weighing myself three weeks ago, I have lost almost a stone. I was so angry and frustrated that I nearly heaved the scale out of the window.
I. Am. Trying. I haven’t been doing anything to lose weight deliberately. I have been following a meal plan and ensuring that I eat at least 2000 calories each day. I’ve been eating a variety of foods, not just the ones that feel safe. That bloody bagel didn’t feel very safe, but I ate it. I’ve also had chocolate. And chips. And bread. All foods that I couldn’t touch at one point. Admittedly my exercise has crept up to extreme levels, as I tried to adjust mentally to not weighing myself multiple times each day. I have not been eating enough to compensate for all the exercise. But as soon as I realised that the exercise was getting to be a problem again, I took steps to check it.
And now I’ve slipped back down and have to re-gain the lost weight. That means upping my intake to about 3500 calories a day. It will take ages and it will be anxiety-provoking and it will mean fending off the thousand and one bloodsucking thoughts that are clustering in my brain right now, whispering that this is good, that I should lose more. When do they go AWAY?
I did everything that was recommended. Swallowed the pills, stuck to the meal plan, went to therapy, and now I’m back down here again. I don’t want to demean my achievements – mentally I’m in much better shape than I was. This is proven by the fact that I am fighting the illness instead of colluding with it. I accept that I need to maintain a healthy weight, and I’m capable of eating a reasonable amount on most days.
So why hasn’t this thing gone away yet? Why am I still ill? What more can I do?
My compulsive overexercise is not something that many people know about. Not my family. Not my friends. Not even those people who are fully aware of my history with anorexia and bulimia.
They know that I walk for miles, swim long distances, go to the gym several times a week, and practice dance for at least an hour every day. It’s hard not to notice these things, as they take up so much time. But people never realise what all this means. They call it ‘healthy’.
“Isn’t Harriet fit!”
“I wish I had legs like yours. It’s all that dancing you do.”
Once I told a friend, nervously, that I was worried about my heart. His response? “I’m the one who should be worried, not you. You’re like a bloody Olympian. I never do any exercise at all.” And he launched into a long monologue about his need to get fitter. Did I think he should buy a gym membership?
An old friend spotted me at the swimming pool and complimented me on my stamina and endurance. “How do you do it? I have to stop for rests!” She asked me questions about swim training as though I was some kind of fitness expert, not a woman who shouldn’t have been using the pool at all. (Swimming can accelerate bone loss.)
These attitudes make it very hard to break away from compulsive exercise patterns. How can I be doing something dangerous when almost everybody tells me that it’s healthy? When they start berating themselves for their laziness right in front of me?
In some cases compulsive exercise can be classed as a form of purging. (Not all bulimics make themselves sick. Some just swim or dance or run obsessively instead, calculating the calories consumed and then burning off the equivalent.) In my case it’s a way of reassuring myself that I’m able to eat. My muscles ache, my trainers have got holes in the soles after just four weeks of wear, my hair stinks of chlorine, and I’ve got a dancing class to come – the frenetic pace and the physical pain tell me that it’s OK, I deserve to sit down and have this meal. Without this powerful physical reassurance, I struggle to eat.
On the day when I can go for a leisurely stroll instead of a fifteen-mile march, enjoy a delicious lunch without planning how best to pay for it (swim or gym?), and snuggle up in front of a DVD instead of doing my evening stretches, I will know that I am healthy.
A friend is visiting next weekend. The meals have mostly been planned. Saturday will involve a chilli chicken burger and delicious crispy golden chips from a small organic restaurant that sells the nicest herbal teas in the world. Sunday will involve either waffles with chocolate ice cream (and lots of chocolate sauce!) or a bowl of tiramisu. I haven’t decided which one I want yet.
The only exercise I will get will be the walk to and from the restaurant on Saturday. An hour’s walk. That’s it.
I’ve got five days to go until then and I’m already petrified. It’s a huge challenge. I keep wavering. Several times I’ve almost picked up the phone to cancel the whole thing. But it has to happen sometime, and if not now, when?
I’m feeling a bit low. What’s the point, future is terrifying, I’m getting old, what if I never achieve anything, what happens when my family and friends all die, all that kind of messed-up thinking that I do know how to challenge but that sits in my head even though I rebut it. The result is a despairing kind of lethargy. I just want to curl up in bed and not move.
I left some incriminating papers around the house while I was off staying with friends (including my assessment report and food diary) and I’m terrified that my mum and dad will have found them. They know about the illness, but they’ve never seen the reports. I don’t want anybody but me and my doctors looking a those papers. It’s enough for my mum to know that I starved myself without reading about the 75-calorie days in detail. Please God no.
I don’t have a weighing scale any more. Mine has been thrown out. I have to weigh myself at the chemist if I really want to know how I’m getting on, and that’s not accurate. I can’t strip off in the middle of Boots. Yesterday I weighed almost as much in heavy winter clothes and shoes as I did stark naked at the end of January, which tells me that I might have lost. But I can’t feel it and I can’t see it. I feel huge. I’m terrified of gaining even more weight.
It’s all so boring. Does it never end?
From something I wrote earlier today:
This is perhaps my biggest motivation to get better. If I weren’t so preoccupied with my weight, intake, and exercise, I would have spent today writing my essays, e-mailing my long-neglected friends, listening to music, playing piano, reading, practising my Irish dancing in the kitchen…and instead I spent most of it walking. Because I felt the need to compensate for all the things I’d eaten. Then I went to sleep, because I was so tired from walking. And now I’m sitting at my desk at 2:15am, fighting the urge to take laxatives and eager to get tomorrow’s (first) weigh-in over with.
What would I think about if I didn’t have the ED to occupy my mind like this? It takes up about 90% of my waking thoughts, possibly more. Assuming I get to be an old lady, will I look back on my life and remember the meals and the purging and the gains and the losses in infinitesimal detail, and see everything else as a vague blur? Because that’s what it’s like at the moment. It makes me so sad – I know I have happy memories of good times, but I can’t access them at all. They’re behind glass. The only vivid memories I’ve got are to do with food, with a few exceptions from childhood. The ED came along when I was still in primary school, so I suppose this isn’t surprising.
Somebody who is currently very ill asked me about the things that I had used to help me when I was just starting out in recovery from my eating disorder. I began to write a letter, but quickly realised that it was too long for anybody to digest in one sitting. So I’ve decided to write a series of blog posts on the things that helped me (and the things that didn’t), in order to make it more coherent and hopefully more useful.
The most important thing of all – the thing on which everything else was based – was truth. The truth, the whole truth, and nothing but the truth.
I used to think that it might be all right just to share tidbits of truth and get help with those particular symptoms, safely ignoring everything else. Perhaps ‘the rest’ would become easier to deal with once I’d had help with the things I was able to talk about. That was my logic, and I knew at the time that it was a lie.
Mental health difficulties form patterns. If you want successful treatment, you’ve got to be able to look at the whole pattern – you can’t just pick and choose certain problems and expect your medical team to be able to help you with those in insolation, because they aren’t isolated. They never are. A good doctor or therapist is going to try and connect the dots, and if you don’t share the full extent of your difficulties, they will end up connecting the wrong ones. This has terrible implications for treatment. I have known some patients who got diagnosed with mental health difficulties that they don’t have because they weren’t truthful about the difficulties that they do have. A doctor is going to make a diagnosis and draw up a treatment plan based on the information that he has available to him. If he doesn’t have all the information…
Once you’ve got caught up in this mess, it gets harder and harder to pull yourself out of it. Some people assume that they can put off telling the whole truth until they are less frightened of sharing it. Again, it doesn’t work that way. You aren’t going to get less frightened. Disclosing your difficulties is always going to be scary, full stop. If you put it off and put it off (letting people walk off with erroneous ideas about your illness in the meantime) the fear will increase rather than decrease, as your brain presents you with two things to worry about: the old fear about what the doctor’s reaction to your difficulties is likely to be, and the new anxiety over what her reaction to your deceit is likely to be. Your illness will prey on this. It will do anything to make you more afraid.
Your doctors are likely to have heard everything you tell them before. The thoughts in your head might seem awful and shocking to you, but to a mental health professional who has worked with hundreds of patients, they are common symptoms of treatable illness. They don’t mark you out as a dreadful person. They are just illness, and thousands of people are currently ill in the way that you are.
If you are tempted to lie or to miss things out (and we both know they’re one and the same), tell your therapist what you are tempted to do – and why. You have told me that you rarely admit to making yourself sick, or if you do, you lie about the frequency with which it happens. Tell this to your therapist – and give her the reason you told me: “I don’t want to be diagnosed with bulimia. I want to be anorexic, because that feels more special.” Then maybe the two of you can work on why anorexia represents something special to you. What is important here: being perceived in a particular way by K, or allowing K to help you with the problems that are making your life miserable? She can’t do that if she doesn’t know what the problems are.
You might think that you can’t be honest because it’s too overwhelming. Trust me: it’s not as terrifying as you think. Afterwards you will feel so proud of yourself. It makes you realise that you are stronger than the illness, which tells you that you can’t do this and you’re incapable of that. If the ill thoughts are wrong about this, what else are they wrong about? When you find yourself starting to ask that question, you know that you’re getting better.
When I entered treatment this last time I always told the truth, even when I was assigned a care co-ordinator who was the very opposite of helpful and who did a lot more than harm than good. It was so tempting to lie to her in order to spare myself the misguided and triggering remarks that I invariably got when I gave her the facts. But I knew by then that I owed it to myself to be truthful, so that I could look back and know that I had done my best. Even if your best doesn’t produce good results, it gives you confidence to know that you tried. It’s much better than the alternative. If you get really caught up in lies and self-delusions then you start struggling to remember what’s real and what isn’t, and you will always be wishing that you could turn the clock back and start again.
Second chances do exist. One arrives every second. So seize this one, cut the crap, and make a start on honesty.
I know it’s strongly worded, but you asked for my honest opinion, and I’m giving it. 😉
This is the best film (and perhaps the only film) that deals with bulimia nervosa instead of its more glamorous relative. The portrayal is subtle, gritty, and painfully realistic. Even though bulimia has never been my primary diagnosis, the film speaks to me, particularly the scene in which Beth reveals her eating disorder to her mother: “It’s not about you! Can’t anything be about me?!”
Like Beth’s, my family is very loving, but that cry has still been in my head for years – in relation to parents, siblings, friends. I’m wary of trying to use metaphors to describe my experience with the illness, as it doesn’t have any neat functions or tidy purposeful explanations, but if it’s anything, it’s a way of carving out space. Beth’s perfectionism, her increasingly violent mood swings, her secrecy and her isolation from friends are all things that I have encountered.
I wish I had seen this film as a teenager. It might have helped me to understand myself better, and perhaps prevented a few things.
(It’s available to watch in full on YouTube.)
I’m home. Almost the first thing I did was to strip off and get on the scale (my standard way of reassuring myself when I’ve been out of my house and eating somebody else’s food without any means of being certain about the calorie content). I was expecting to have gained a lot of weight, thanks to the marmalade chicken and roast potatoes and chocolate orange cake and fish and chips and cream of mushroom soup that I ate while I was away.
The scale registered a loss.
I hastily shoved it back under the bed. (It managed to get itself brought down from the attic and reinstated in my bedroom several days ago.) This should be confirmation of what my medical team have always told me: square meals and proper nutrition don’t result in you going up two dress sizes. Bodies need fuel and they know how to use it. Unfortunately seeing those numbers has had the opposite effect on me. Now I want to lose more. Not much. Just a little bit more. This is why I should not be weighing myself, ever, because for me it will probably always feel this way. Alcoholics can’t become social drinkers, and ex-ED sufferers can’t become sporadic weighers.
The centre was helpful. I arrived just in time for lunch yesterday, and was shown into a light airy dining room where a small bowl of carrot and coriander soup and a crusty bread roll were waiting in my place. There was a cheese board too, but it was up to me whether I had any cheese or not. I was expecting to feel some emotion as I broke up the roll, softened it in my soup, and swallowed the pieces – guilt, disgust, satisfaction, exultation, something – but there was nothing, unless you count a weary kind of relief. Whoever prepared that meal must have had some understanding of eating disorders, because they had chosen something that is nourishing yet non-threatening. They had decided on the main meal for me, but given me some choice over what extras I had on my plate. The result was that I didn’t have to go through agonies of choice or feel panicked over a lack of control. It was as painless as my meals ever can be.
It was nearly impossible to tell the difference between staff, ‘ordinary’ guests, and guests who had come with mental health problems. This made the atmosphere at the table very relaxed. I knew that Jane was a therapist on the team, and that she was sitting next to me in order to provide support and supervision, but no one else was aware. By the time bedtime came I had begun to feel as though I knew everyone well – still without knowing why exactly they were there. I like the privacy this system provides, the distinctions that it breaks down.
After lunch I went straight to bed. I haven’t been sleeping properly since I began to slip. Usually I’m still awake when my parents get up for work at five-thirty. Now the exhaustion crashed over me like a wave, and I napped through till coffee time. A staff member brought me a cup of tea and a generous piece of chocolate orange cake. I ate it. Thoughts about doing some sit-ups to redeem the calories fluttered to life. I rolled over and went back to sleep. My room was like a little pink-painted cocoon.
I didn’t receive any therapy until yesterday morning. I think that was a good decision too, as yesterday I would have been too edgy and nervous to concentrate. I needed the chance to settle in and get familiar with the routine of the house. My therapist was also a vicar, so I had the opportunity to speak about spirituality in a way that I’ve never been able to do with any other medical professional – how I can use it to help me at this time. We talked about Christianity and the space it creates for grief and loss. How to mourn. How to move on.
One day I may write a funeral elegy for my eating disorder. It was a close friend at a time when I needed friends, and I will miss it. That is something that not many non-sufferers understand. It would never have taken over my mind if I hadn’t needed it in some way.
I don’t know who I am without it, and that’s something I need to figure out. Then perhaps we can finally say goodbye.
1.) Pyjamas. Hopefully I will actually do some sleeping at the counselling centre.
2.) Safety snacks, just in case.
5.) MP3 player. Delete all songs that remind me of difficult times/add to ED thoughts. (Replace with what? Whale music??)
6.) Handkerchiefs, in anticipation of possible crying.
7.) Calorie guide, to check unfamiliar meals.
8.) Laxatives.8.) Assam tea.
9.) The Imitation of Christ.
10.) Hopeful attitude: “Live in the present, remember the past, and fear not the future, for it doesn’t exist and never shall. There is only now.” (Christopher Paolini.)
The centre staff have asked me not to bring a laptop or a mobile. (Well, I can bring them, the staff just think it would be helpful if I didn’t come online during my stay.) I will be back on Saturday night. Until then.
…why do they all snore so loudly? My room is right next to Mum and Dad’s (one has a snore like a bubbling saucepan, the other sounds like a lawnmower) and across the landing from Younger Brother’s. I won’t even try to describe what he sounds like.
I’m the only one who doesn’t snore at all. Well, they tell me I do, but at least I don’t keep myself awake doing it.
It’s been about two months since my discharge from all services, and two days ago I did what I prayed I would never have to do again: I rooted out the resource pack that my care co-ordinator gave me ‘just in case’ and dialled one of the phone numbers in there. I’m barely eating and the thoughts are getting more vicious with every passing day. It’s very hard for me to make this admission, as it feels like failure. (I worked so hard to get better, why I am slipping down the rabbit hole two months after discharge?) But failure-feelings be damned. You’re just part of the illness, and I’m not putting up with your crap this time.
When I’ve been struggling in the past, my CPN has either given me a workbook to fill or asked me to come to the clinic ‘to chat about the way things are going’. That’s not enough. I am aware of the way things are going and I know what started all this off. Sitting in her antiseptic-smelling office and dredging through January’s events with the CBT net won’t help here. I need someone to sit with me at mealtimes and help me get the food the down, because right now I’m too scared to swallow. I didn’t know how I was going to explain this to her, but fortunately I didn’t have to. I was able to speak to the psychiatrist himself, and he suggested an intensive admission of two or three nights to help me get back on track. For various reasons, it turns out that this is not possible. But I have found something that might be even better.
There is a short-stay Christian residential counselling centre not far away from me on the train. It accepts self-referrals. It offers a quiet place to pray and think, along with access to accredited therapists who work in different specialisms. I contacted them and told them what I needed: a tranquil environment that I don’t associate with my eating difficulties, some gentle support at mealtimes, and a person to talk to about the horrible events that have made things get so difficult all of a sudden. They have a place for me immediately. When I hesitantly asked about money, they told me not to worry. It’s donation-only. I just give what I can afford. Relief.
I am going down there the day after tomorrow and staying for two nights. Seven supervised meals. I hope it’s enough.