Wednesday, 21 August 2013

Advice on Getting Over Anorexia Part I

Anorexia Nervosa: media friendly psychiatric diagnosis that has been providing method-acting weight-loss opportunities for young actresses for several decades.  I used to love the idea of anorexia. Even the word itself: it starts with an A, is pleasantly classical and has that spiky x there to give it an edge.  I now realise that anorexia is about as edgy as a round cushion. The contrast between its public image and the excruciatingly banal reality can only be matched by that between media portrayal of drug addiction and the boring existence that that actually is.

This recent article from The Huffington Post reflects the perplexity anorexia creates, including amonf the medical profession. The out-of-body experience recommended here is nothing compared to this other treatment . If you can't organise an out-of-body experience or brain implant this week, here are my tips for getting over anorexia.

(It feels like time for a disclaimer: you might have noticed that I'm not a doctor or any other kind of health-care professional. I have no qualifications related to eating disorders beyond my experience and observations. Therefore my advice, while invaluable, does not constitute medical advice. )

1. Depathologise
In an interview for the HuffPo article above, Susan Ringwood, Chief Executive of BEAT, refers to anorexia as a "condition". Contrast this to the article, which calls anorexia "an illness". You might think "same difference" but I believe there is nothing to be gained from calling anorexia an illness, or worse, a disease.

Anorexia's one of the older diagnoses, predating the DSM, and is neatly called an "eating disorder". A disorder does not constitute a disease, as James Davies explains in "Cracked: Why Psychiatry is Doing More Harm than Good".  Diseases are physical entities with verifiable causes. Disorders are clusters or as Davies calls them "constellations" of feelings and/or behaviours.

Anorectics are often portrayed as being unwilling to admit that they are sick and in need of treatment. This reluctance is, in  my view, a ruse. They might well be avoiding treatment but that is only so they can travel further down the anorectic road to some sort of perfectly skinny destination. Anorectics do believe that they're "sick" but it's "sick" in a general sense. They might even believe that their brains and metabolism are abnormal. I know I did. Putting pressure on an anorectic to admit that she is sick may be understandable where weight-loss is dramatic and feared irreversible without hospital admission, but that does not mean there is any underlying pathology.

So if you're anorectic, you do not have to accept that you're mentally ill. You might have gotten yourself into such a state that a short stay in hospital may be an option, but this is best viewed as a chance to get your strength back. The doctors are not going to break into your skull and fix your wiring. You are not doing this because somewhere in your DNA a cytosine swapped places with an adenine. You're doing it because you're dissatisfied and the sooner you face this the better.

But if anorexia isn't an illness, then why do the symptoms seem to cluster together to form a syndrome? (Symptoms is a medical word that should have no place in your thinking in relation to your problem). This is because anorectic behaviour forms a pattern. Nature loves patterns and they love to reproduce themselves, which is why anorexia can be hard to break out of unless you substitute the pattern with another one. We also know that some behaviours, like obsessing about food, are functions of calorie restriction. They are not a sign of mental illness, as this experiment where male conscientious objectors volunteered to undergo a year of semi-starvation shows At around 9.15 minutes in the volunteer talks about buying cookbooks, and also about the depression brought about by lack of food.

On  a lighter note, this a short piece from minbodygreen where Isabel Foxen Duke explains why, for her, even the phrase "eating disorder" is unhelpfully medical.

You are not sick. You do not have an illness, or a disease. You have a problem that needs to be tackled. Doctors, hospitals and counsellors may help but that's all they can do. The problem's origins, expression and solution all lie within the scope of your own life. A life that is your own responsibility.

2. Have a Plan C
Ask yourself where you're headed right now. People love telling you this when you're anorectic "If you don't cop yourself on you'll end in hospital". You'll be threatened with tube-feeding, osteoporosis, infertility and told that you're risking your life.
Some of these risks are real, some exaggerated but none of them scare you. After all, what's the alternative?
Those admonishing you take an alternative for granted; that you cop on to yourself, count your blessings, stuff your face and go back to being the lovely girl they all miss. To you this is so scary that you're putting yourself through pain, discomfort, and would rather risk your life rather than go there.
Like the Carlsberg ad says (not that you'd ever drink anything as calorific as lager) there's always another option besides A and B. Think about what Plan C might look like. You probably already have and have dismissed whatever kind of life you'd like to see yourself living as fantasy. Parts of it probably are fantasy but I want you to go back again and look for elements that might be more realistic.
Imagine a Venn diagram. A, unsurprisingly, is for anorexia. B is for the lovely girl option. What A and B have in common is that you don't have to change. What B and C have in common is that you have to eat a normal amount of food. What do A and C have in common? Most likely, what A (continuing down the anorectic path) and C (choosing to take responsibility for your own life) have in common is that you'll piss people off.
The centre of the diagram, where the three circles converge, is that you are the person most affected by your actions. This is true even of B, where you attempt to recover from anorexia without change. B is unsustainable without developing hidden coping mechanisms such as bulimia or self-harm. Even then you'll eventually embrace C or relapse into A.

3.Eat Real Food
You knew this was coming, didn't you? A few years ago, the US economy went through something called a jobless recovery. (This is where my economic knowledge begins and ends. You can find out more about this subject here He writes well  but could be wrong for all I know). Well, the jobless recovery didn't do much for actual people. It just worked in theory, just like you going to your counsellor or your psychiatrist and working on your issues or taking your anti-depressants will do nothing for you unless you eat something. Eating normally will make you put on weight, but it is normal eating that is the aim, not weight gain.
Doctors love weighing you because they all did lots of science in school and more in college and think it's useful to measure things. You may have noticed their graphs and curves and their love of doing sums such as working out your BMI. This measurement is for them to gauge how you're doing with the food, but you don't need to worry about gaining weight because you know yourself how much you've eaten. You also know whether or not it's a normal amount.
The good news is that while doctors won't consider you recovered until your BMI is within the normal range, you can actually recover before then. Because the day you stop starving and eat a proper meal is the day you recover.
There used to be an eating disorders support group called SHINE. It was an acronym for Self Help in Normal Eating, and I really think they were on to something. For you to live your Plan C, and to leave the role of sick person behind, you must eat normally. Don't gorge yourself or lie in bed and sip Complan. Eating normally means three meals a day, with maybe a couple of snacks. It means mostly savoury food, with lots of vegetables, slow-release carbohydrates, protein foods and more fats than you're used to. It also means gaps of up to several hours between meals. Others might love serving you endless food or encouraging you to graze, in the belief that what matters is that you put on weight. This is a mistake; eat enough at mealtimes and the weight will return. And by enough I mean plenty; not a bowl of Special K for breakfast and an undressed salad for lunch. If you enjoy cooking, go ahead and cook all you want, as long as you partake.
Some "experts" are big on the idea a restricted diet is a symptom of anorexia and recovery must involve eating taboo foods like chips and chocolate. Others (including a consultant I went to see) insist that you must eat meat. My own view is not to worry if eating chocolate or burgers scares you. Plenty of normal people never eat them and your fear of certain foods will subside once you get back into a normal eating pattern. So as long as your diet is half-way normal, it doesn't matter if it's a bit restricted.

That's it for the moment.
These are my own thoughts, based mostly on what has helped me. They may seem a little simplistic - especially "eat normally to recover from anorexia"duh - but sometimes I think we can overcomplicate things. From my own experience, I had some highly-trained and expensive minds trying to figure out what was up with me and which chemical compound would fix the glitch, when all I needed was some encouragement and reassurance. I also think there's a massive eating disorder industry, from publishing to treatment centres, that benefits from making anorexia a complex issue beyond the reach of common sense. Professional help can be useful, but in the words of Groucho Marx "It's good to keep an open mind. But not so open that your brain falls out." Your brain got you into this mess (when's the last time you saw an anorectic dog?) but it's also your best hope of getting out of it.

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