Escaping from Anorexia
What makes someone with anorexia start eating again?
Posted Sep 06, 2009
I emailed a friend recently, to tell her about my blog - and in so doing reminded her of my recovery. She still has anorexia, as she has had all her adult life, and in her reply she hoped that I wouldn't ‘go back': she hoped with all her heart that things wouldn't imperceptibly change, through fear or curiosity or whatever else, so that I should find myself back in the darkness again without having even realising how it had happened.
This little exchange made me think, as lots of little things trigger me to do, about all that has changed since I regained a weight that's healthy for me. I've gone from having a ‘life' as skeletal as my body to acquiring all the usual things that people have: a partner, a car, a job, weekend plans, some hours in every day not spent working or preparing food... I haven't got all the things needed for a rounded life yet, by any means. Compared to my brother's life - all the skills he's gained over the years, the house and the hordes of friends he has of varying closeness - mine is still quite constricted. But all the things I already have contribute to make a barrier, or an enveloping atmosphere, that makes regression more difficult with each new element, each new building block that's added. When you're still ill, still thinking of nothing but food and how to get by till it's time to eat, the very idea of recovery seems laughably precarious. Even if you were to eat and eat and eat till you were the same size as everyone else, why should that have changed anything in your personality, or your circumstances, or your needs and desires and weaknesses - any of that which led you to self-starvation in the first place? This has been your comprehensive coping mechanism: surely the next crisis will topple all that ‘progress' like a sapling in a storm, surely you'll remember with a rosy glow what starving did for you, surely you'll retreat back to that one thing you know you could do so well.
No. Life intervenes. Life comes with all its complicated delights, and prevents that backwards sliding. This is the same life that, when you were still ill, kept disturbing you with its problems - mainly other-people-related -, kept reminding you, insistently, in your darkest hours, that this wasn't tenable. There's a neat symmetry: now it's my own life which provides a buffer zone between me and relapse, and last year the impulse to change was also made up of an accumulation of incentives, an ultimately undeniable roll-call of reasons from the outside world. Some were tiny momentary things, others were long-running and weighty. At some point the mass of all those things in my head moving me towards treatment and recovery took on its own momentum.
As I say, other people were the main thing. My mother and her partner, who were moving house, decided, and told me, that they couldn't bear it any more: they couldn't face the idea of my illness coming like a black shadow to be cast over their new home. He couldn't bear my cooking for the family and never eating, or my nocturnalism; she couldn't bear any of it, and least of all how it threatened to ruin their relationship too. ‘You are welcome at the new house', she said, 'but your anorexia isn't.' At the time, that amounted to being thrown out by own mother; and I wept and raged.
That was an important negative stimulus. After all these years of attracting the anger and criticism of my father and other relatives for having ‘encouraged' me by not throwing me out, by talking to me about my anorexia rather than denouncing me for it, even my mother had had enough. I think if this had happened much earlier, it would have been too soon, and I would not have been ready. But as it was, it became part of the general upsetting of the uneasy equilibrium that made staying as I was possible. Two friends of mine (almost the only friends I had left) then took up the cause in a more positive sense.
One, by means of who knows how much online research and how many phone calls, found out about an eating-disorders clinic in Oxford, and got in touch with them to learn more. She told me about it, and came to see my doctor with me to discuss it, and encouraged me to go for a preliminary meeting. Without her, I would never have known about the treatment-research programme, and would have missed the fast-approaching deadline for new patients. And without the cognitive behavioural therapy - about which I was pretty sceptical at first - I don't think I would ever have got better as well as I have.
The other friend was tireless in supporting me through the evening in a bar where I worked my way gradually towards a decision: from 'is there any point in trying?' to 'do I say yes or not?' to 'am I ready or not?', to 'I think I have to, don't I?' to 'OK, this is it'. He helped me in the practicalities of recovery, starting on that same evening of finally saying yes to breakfast the next morning and a snack the next afternoon. I couldn't bear to go into a supermarket on my own, to spend my money on food I was scared of, so he came with me, and together we chose the pain au chocolat and the custard tart, and then he bought for me enough supplies for a few days. And he talked and talked with me about what I feared and what was changing, in my mind and my body, over all the months. Without him, too, I couldn't have managed it, not in the same way.
Then there were the things that came from me - or rather, from the way of living that I had created for myself, and which increasingly came and clawed at me like a vicious half-tamed creature. I was lucky in having no serious physical symptoms, probably because I was so rigid in my eating and not-eating: always just enough to get by; no exceptions, ever. But the cold, the weakness, the hunger itself, became gradually more oppressive; I was terrified of all three, even while they proved my power to myself and the world. The nocturnal habits grew more and more debilitating, too: deferring food was proof of strength, so it was a triumph always to be a little later than yesterday before I had the first in my series of pre-food drinks, or began to eat, or finished eating. However often I resolved that tonight would be different and I would get to sleep earlier, there was always a perverse pleasure in failing, in staying hungrier longer. So the day's single meal would be at two or three or four or five in the morning - one winter it went all the way round the clock, several times, so for a week or so I'd be going to bed at nine or ten in the morning, and then soon be back round to ten at night. This doesn't make for a good mood or many social opportunities, to put it mildly. Waking up to a wintry sunset is one of the most depressing things in the world, especially when you must now go for a bike ride and work for eight hours or so before eating.
Then there were the obsessive-compulsive behaviours, which I now know to be closely linked to weight loss, but which at the time felt like incipient insanity. I would spend longer and longer checking the word counts of all the Word documents I could think of before I switched off my laptop for the night; I would go outside into the night and make myself memorise all the car number-plates, go to the loo multiple times, pull out a handful of my hoarded food-wrappers to look at their calorie contents - all completely pointless things whose only purpose was in having done them, just so the anxious urge to do so would abate for long enough to let me finally eat and sleep. They cut further into my sleep and my energy, and they angered me so very much - because of course I could see their ultimate emptiness all the time I was succumbing to them. Shopping became more and more difficult, too, as I needed to check the nutrition information and the prices of more and more things before making my escape with lettuce and the cheapest white sliced bread or whatever. My diary, which I kept every night, began to take hours rather than minutes: by the end, I was mostly writing about the impossibility of stopping writing.
I had moments of becoming sickeningly aware of my own physicalities, as in the evening-dress episode I mentioned in this post: moments where I saw how repulsive and inhuman I looked, and felt so unbearably sad at knowing it and not knowing anything else. Being continually close to tears was another part of life that I hardly realised was abnormal till my consultation with the therapist, who instantly prescribed Prozac for starvation-induced depression after I'd burst into tears at my guilt about my mother, and described in telling outlines a life of only just coping, emotionally as well as physically.
There was a day down by the seaside, during which I sat for hours on the beach staring at the sand and the sea, and briefly felt complete calm and a sense of the sufficiency of the present moment. I understood how completely my way of living - endlessly postponing things to make their pleasure all the greater - was precluding feeling like this. I read another news story about an academic who had anorexia dropping dead of heart failure while carrying home heavy bags of shopping. I couldn't go skiing with the family, again, as I'd so loved to when I was younger. I had no sort of relationship left with my father. I needed another pair of tailor-made trousers, because no ordinary ones would fit.
Eventually, it was too much to ignore. A sense of urgency came upon me. Fear, and the need to cling to what I knew, was still balancing it out, but every little thing more brought that balance closer to tipping. A month after starting on the anti-depressants, I was going for a second appointment, and then there would be the day on which I woke up, as on any other, with hunger and the cold certainty of its continuing, but by the end of the day would be writing in my diary: ‘All is changing. All has changed. Today is my last day of starvation - and I feel as though I'm losing, bidding goodbye to, my most beloved companion.'
Next week I'll begin to talk of how that farewell felt, and what it was like to leave my fair loyal friend starvation ever further behind, and begin to build up that barrier of life between us.
(A year-and-a-half later I wrote a sequel to this post, venturing further beyond my own experience to ask why starting eating is so hard and how to do it anyway.)