I’ve given my therapists a hard time over the last few months. I consider myself to be a relatively intelligent individual who is in tune with her thoughts (the good and bad) and can effectively communicate them.
I know my underlying issues which I have taken to extreme lengths and which have resulted in my depression and anorexia. I have wanted to address these issues with my psychiatric team. I am an all or nothing person. When I commit to something I give it my best and I give it my all. So, you can imagine my frustration when the professionals tell me that I am not ‘cognitively able‘ to deal with such issues at this moment due to my low weight. I could not (and to a degree still now) do not accept this.
How dare they claim that my cognitive function is impaired by my low weight. To counter their ‘ridiculous’ claims I got numerous textbooks from the library and studied the science behind diet and nutrition. I studied the various psychological theories and their respective practitioners. I’d play them at their own game. I’d show them that they didn’t know what they had when they were dealing with me. I’d show them that I can take on whatever they’ve got to throw at me. I can talk about the things that are eating me up inside without it pushing me over the edge!
….or can I?
When it comes to my life, be it buying a car, considering my financial situation, my mental health, the first thing I do is research. I want to be able to talk to on some kind of par with the people involved. I don’t presume to be an armchair expert in any of their fields, but I use my research to give me a basic grounding, so that I can question and try to understand at a deeper level.
My dietitian once asked whether I would expect a client to come to me for legal advice and then proceed to tell me that they have already consulted the Law of Property Act. Truth be told, I’d take my hat off to them and give them an understanding nod of respect!
Notwithstanding the incredibly arrogant tone emanating from the above paragraphs , I am the first to admit when I don’t know something. I am the first to ask a question when I don’t understand. I am not ashamed if I haven’t grasped something or don’t know it. I am receptive to and respectful of other people’s views, knowledge and experience. I don’t know it all, but I thought I do know myself!
So, when I read the following in a psychology article (please see the link at the foot of this post for the complete article) I could do nothing but hold my hands up and very quickly clamber down from my high horse:
The emboldened words are those which particularly struck a chord with me.
The italicized words are my comments.
Starvation study shows that recovery from anorexia is possible only by regaining weight
There is one finding about anorexia which seems to me more crucial to treating it successfully than anything else. It is a counterintuitive insight, but one that seems – like all the best facts – completely obvious when once one knows it. It is this: that for the anorexic, gaining weight is the prerequisite for mental recovery, rather than vice versa. Put another way: you can’t make an anorexic want to put on weight until he or she has begun to do so. Put yet another way: the mind may make the body sick, but only the body can help the mind be well again.
The above has been the mantra of my various therapists for months. My argument has been that it is a vicious circle; my underlying issues are preventing me from eating freely, if we don’t straighten them out, how can I feed my body?!
Christopher Fairburn’s Cognitive Behavior Therapy and Eating Disorders(2008: Chapter 11) describes how some of the effects of being underweight (i.e. having a BMI below 17.5) contribute to maintain the eating disorder: being preoccupied with food and eating, becoming socially withdrawn and losing interest in other things. Becoming indecisive, feeling a heightened need for routine and predictability, and feeling heightened sensations of fullness after eating, all help create vicious circles in which the only way to avoid mental or physical discomfort in the short term is by keeping on starving, but the only way to escape these problems in the long term is to regain weight. He also emphasises that while sufferers of anorexia will be convinced that their present state reflects their personality, in fact their personality is masked by the effects of being underweight and that their own personality will only emerge again if weight is regained. Anorexics sometimes fear that they will stop being ‘special’, or stop knowing who they are, if they regain weight, but of course there is nothing special about being severely underweight, and ‘who one is’ is irrelevant: one is simply the same as everyone else who is severely underweight, just like the brave men who participated in the Starvation Study. One’s true character remains hidden when the body is starved, to be rediscovered by starting to eat again.
Point noted. Effecting that point is the challenge.
The two facts of key importance to the sufferer of anorexia who is aware of the bleakness of the way in which he or she is living but cannot resolve to change are as follows:
1. If you regain weight, not only the physical effects of your current state – being constantly cold and weak, sleeping and concentrating poorly, bad hair and skin – will disappear, but so will the ways in which you currently think and feel. Your body is starved, and your character and your thoughts are dominated by this starvation, and will cease to be so once you allow yourself to regain weight.
2. There is no point in waiting for the magical moment at which you decide, once and for all, that you want to start eating more again, or to regain weight. Your starved state is making you unable to think flexibly enough to fully comprehend the possibility of eating or living differently, or even the possibility of wanting to think about and enjoy things other than food; it has hidden from you who you really are, and made you believe you are nothing but the anorexia; it is making the smallest piece of food feel like too much. For these reasons you will never truly want to recover, but you have to seize all your feelings of despair, desperation, hope, recklessness, and curiosity in order to make yourself plunge into that first day and first meal of recovery. As long as you keep yourself going, keep eating, through the first difficult weeks, it will get easier and easier.
I was so incredibly struck by this when I read it and again today reading it. It is so true.
My current BMI is still below 17.5.
I think I have overcome most of my issues with food. Not so. When my depression hit me badly a couple of days ago I denied myself lunch. I sat in a cafe with an apple cut into chunks on a plate whilst my two best friends tucked into their delicious looking lunches that I so wanted.
This afternoon travelling into town I felt hungry. I thought I’d have a yoghurt but decided against it because I wanted to have a latte in Starbucks. I felt hunger but denied myself. My head told me that I was just being weak if I ate something. I didn’t need it, the latte would be sufficient and was a treat in itself.
How to break this mindset? It seems the only thing for it is to switch to auto-pilot. To just eat; not think, feel, question, consider, challenge, delay, or barter.
And that’s where this overthinking, control freak falls down. The prospect fills me with terror and utter confusion. I am careful, I plan, I make safe, considered decisions. You’re asking me to approach the edge of a cliff and keep walking in the hope that somehow a path will emerge before me and I won’t fall. I’m not stupid! If I walk off that cliff I will free fall faster than Felix Baumgartner and my landing will be decidedly more messy.
I keep myself measured so that I don’t fall apart. I can’t let myself go.
I don’t believe anything will catch me if I step off that cliff edge.
For all my efforts and thinking I have moved forward I have only increased my comfort zone ever so slightly and I remain utterly rigid within that zone.
Until I throw caution to the wind and embrace flexibility I am going to remain in this so-called comfort zone that is in fact a straight jacket.
I need to act.
I don’t know whether I can.