Tag Archives: bulimia

Loose ends.

For those of you who responded so kindly and with such interest to the post about eating disorders, this update is an effort to answer the question about what you could/should do if someone comes to you for support. I'm sorry, it was stupid/unhelpful to publish a list of 'don't's without suggesting any 'do's. 

As you know, the blog will come to an end on Sunday but you can always email me regarding this issue if there's ever anyway that I can do anything to help.  

If you can, you should try and guide the focus away from weight/food and get them talking about what was going on when they started cutting down their intake. What were the feelings and circumstances that led to self-denial; why did they feel judged, why did they feel inadequate, what happened to make them feel like they didn't have any control? A lot of them will immediately cite appearance related issues but, if you can, try to steer away from these and dig deeper - the social pressure to be thin undeniably, (and unforgivably!), exacerbates eating disorders ten thousand fold - but the vulnerabilities that make a person particularly sensitive to appearance related judgements don't start with appearance, they end with it. If they will talk to you, then don't offer them platitudes - they can be very clever people, thinking highly complex thoughts about the way the world works, (this is not always true but it's better to start here and adapt your approach than it is to trivialise the depth of their thinking and have them shut you out). Coming to the conclusion that you don't have much control is not illogical, it's just hard on a person if, for some reason, they have had to face it before they were ready. That 'life is NOT fair' is a more manageable concept if it dawns on a person incrementally over time – but, if someone has been unexpectedly or abruptly exposed to extreme feelings of powerlessness, especially a sensitive person who may have thought that by following certain rules they could guarantee certain outcomes, then being overwhelmed is a fairly understandable response.  If you can, try and help them to explore and make peace with this new, out of control world - this world where you can influence other people's thoughts and deeds but you can't MAKE them feel or do anything, this world where, no matter what you do or how hard you try, there are certain things that all the willpower in the world will never change. From here you can start to help them explore whether there are any possible benefits to living in a world where control is an illusion. A person who is trying to be perfect by following rules is under a tremendous amount of personal pressure - if you can open up their mind to asking whether or not, since doing X doesn't always guarantee Y anyway, perfection might not be a mugs' game, approval might not be a matter of perspective and being motivated by your own wants and needs, rather than a desire to please others, is not just acceptable but probably both rational and enlightened – then you may succeed in edging them in the direction of hope; if you can help them start to see 'a world without control' as 'a world without the pressure to be perfect' then, in time, this may develop into a lifeline.

You should also try to find out what they are good at that is unrelated to food and exercise - in an ideal world it shouldn't be something academic because academia has competitive connotations and the last thing they need is more comparisons - whether it's writing, painting, playing an instrument, craft projects, photography, caring for animals, making people laugh, being a good listener, being a good organiser, creating fun activities for children etc. - and find a forum where they can do this thing and receive affirmation for being good at it. They need to be praised for things that they see as 'innate' - if they only receive praise for being good at things which are competitive, like good grades, career promotions, success at sporting events etc. this will reinforce the idea that their value lies in their ability to perform rather than simply in the very fact of their being.

29 January 2014

I am not usually a sedentary person; Bauer and I probably average about 7 to 10km a day - sometimes more, sometimes less - but he benefits fairly significantly from a finely tuned guilt complex, wrapped up in the remnants of a lingering eating disorder.  The eating disorder hasn't been life-threatening for a very long time and I don't normally talk about it because, compared to what it once was, it is now a manageable cross; one born by more people than you might imagine.  Some people know.  Some people don't.  It would be easy enough for a person not to realise since it doesn't always manifest itself as anorexia - I have also been severely bulimic, as well as having periods where I have an eating disorder in the same way that someone who has been an alcoholic is 'always an alcoholic' - I might be winning the battle not to starve or stuff myself but, make no mistake, beneath that serene exterior there is most definitely a battle going on. Archie often asks me why I don't write about eating disorders since I have so much 'experience' and such incredibly strong views on the subject - and I always tell him that it's because I've rarely read anything written about them that isn't just part of the problem. Most people aren't aware that eating disorders have the highest mortality rate of any mental health condition known to humankind. If you are not careful about what you say you might just kill someone - maybe not instantly - but your misguided word or phrase will lodge in their poor diseased brain and torment them to the brink of collapse. It's not that people don't mean to be careful what they say - it's just hard to be careful what you're saying when you don't really know what you're talking about.

The first two massive, fundamental, epic misnomers are that a conversation, article or other discourse about eating disorders, especially anorexia, should centre around 'food' and 'weight'. This is the most tragic and corrosive misunderstanding of all - and probably the biggest reason that eating disorders have such a high mortality rate. Why? Because you simply can't solve something by making it worse. If you are trying to communicate with, connect to or understand a person with an eating disorder you absolutely should NOT make ANY reference to what they do or do not eat or how much they weigh. I cannot tell you how sad it makes me to know that when a person goes to the doctor in this, or any other western country, to ask for help with an eating disorder the first thing the doctor will do is put them on the scales. To do this is to completely misunderstand the mindset - all you have now done is given them a number which they will be compelled to drive down by the next time they see you because otherwise they are 'failing' to do well at having an eating disorder. Now, to add insult to injury, people will also be given a BMI and told what range they fall into - in fact, if they don't fall below the 'normal' range they will be told that they don't have an eating disorder - even if they know themselves that their relationship with food is severely compromised. A person who has a sub-normal BMI will realise that they are only in the 'underweight' category and not in the 'severely underweight' category which will flag up for them that they are 'failing' to be as good at being anorexic as other people. You have to understand that a person asking for help will have 5% of their brain on their side, while 95% of it will be resisting, wildly absorbing any information it can find to fuel the disease and resist this 'temptation' to 'give up', to 'fail', to be 'tricked' into thinking that it's OK to eat more. Anorexia is hugely competitive, the person is trying to 'improve' themselves and they've locked on to the idea that this can only be done by losing weight - NEVER give them more numbers, do NOT compare them to other people and don't ask them what they eat because they will be tormented to admit that they eat anything at all - and, if they do tell you what they've been eating, they will be compelled to eat less to ensure that the next time you ask the same question they have 'improved'. This competitiveness is also why putting a whole bunch of people with eating disorders in a treatment centre together is about the most epically stupid thing that psychiatry has ever come up with. Up until a certain point people with eating disorders should be kept as far away from each other as possible - by putting them together you are just compelling then to compete with each other. They won't want to but they won't be able to resist. If a person goes to a doctor and says they have an eating disorder why is it necessary to put them on the scales? If they think they have an eating related problem, then they have an eating related problem - you don't need to weigh them to prove it to yourself, it's not about you; you don't need to categorise them as having a better or a worse problem than someone else, what earthly difference does it make? You just need to HELP them.

The other fundamental misunderstanding that drives me mental is the commonly heralded medical definition of anorexia as being 'a loss of appetite'. Are you crazy?!!! These people are fucking starving! They are obsessed by food. They are desperate to eat. They are hungrier than you've ever been. They haven't lost their appetites, they've lost their minds - help them find their sanity, help them escape the cult like mentality which has taken over their brain. They're not refusing food because they're not hungry - they're refusing it because they're terrified that eating it makes them a worthless failure that doesn't deserve to live. Don't try and rationalise it, (they won't eat, so they must not be hungry); it's NOT rational, it's an illness, it's not playing by logical rules.

Obviously anorexia and bulimia are not the same thing - and I'll spare you my bulimia rant - suffice it to say that you shouldn't talk about 'food' or 'weight' to these people either. Weight is the barometer by which people with eating disorders are assessing their worth - but conversations about weight won't help them to solve their problems. Their issues are complex ones of inadequacy, worthlessness, imperfection, feeling judged, feeling powerless, feeling overwhelmed, feeling depressed. They are suffering from an inability to cope with the lack of control that is living - they are trying to construct a world with black and white rules so that they can survive. They are killing themselves to stay alive. If you understand that then, maybe, you can start to help them.

So why do I mention all this - or even any if it? (Especially as I will delete this post long before any child of ours ever gets anywhere near it.) I mention it because my eating disorder is one of the few things that I never intend our offspring to know about their mother - and I know that the only way I can bring this about is to be entirely normal around food from the moment that they are born.  I couldn't live with myself if I passed on these feelings of inadequacy.  I don't care what it costs me; I don't care what I end up looking like.  If we are lucky enough to have a child, especially if it's a little girl, they are going to think that their mummy loves herself; that their mummy thinks she looks good in everything that she puts on... that their mummy has never, EVER, equated weight and worth. They will get enough complete crap rammed down their throats by the media - they will need at least one half-decent female role-model and it's going to have to be me. It has been hard for me but I have been eating in healthy quantities since we started this process - and it has been made harder still by the fact that now I can't even go for a walk, (exercise and eating disorders - the very best of frenemies), but I am writing it down, saying it out loud, publishing it for the world to see so that it's out there and there's no going back.

Of course, having gotten this epic weight off of my chest, I'm almost guaranteed not to get pregnant!  Today has been the hardest day so far - the OHSS doesn't seem to be getting any worse which is not a positive sign.  Please don't post telling me not to worry though – just for today I don't think it would help.