Leaving Anorexia: The Road to Recovery
Over the past year, several notable research studies have shed light on some of the biological influences that contribute to anorexia, and have pointed the way to potential new treatment approaches and underscored the fact that this and other eating disorders may be more common than we may think. As much as I have wanted to cover this topic for Mom Psych, the task seemed to require someone who knows a lot more about it than I do—and today’s guest blogger does. Lauren Parkes, the niece of dear friends in Australia, is very intimately acquainted with the challenges of living with an eating disorder. We are privileged that she is willing to share her experience with us in the following post.
Last week was mental health week, and I wanted to do something to raise awareness about something really important, but I was scared of what people would say. In fact, I was so scared of this that I changed schools, changed my name. I retracted from the social sphere because I wanted to disappear; to not be judged. I hoped I’d find happiness in places where traces of me did not exist. I wanted to get smaller and smaller until I stopped stealing oxygen from the rest of the population, to suffer through this thought-pattern in silence.
But I know now that that doesn’t help anyone; it means I went through this for nothing, which in retrospect I don’t believe to be true. Now I’m tired of denying I have suffered from acute anorexia for the last year, and lesser so in the years leading up to it, in fear of seeming whiny and attention-seeking (when I’d much rather dig a hole and hide in it). Why? Because it’s just making people continuously think—just as the media suggests—that living the way I and other anorexics do is okay. Normal. That we are healthy. I’ve been sick of girls telling me, when at a forced-hospitalisation weight, that I had an enviable figure. Even the nurse that was supposed to be looking after me said she wished she had my problem, whilst she inserted my nasal-gastric tube to pump food into me (I know. Messed. Up.)
I have to say something because it’s just not okay for people to want to live the way myself and other sufferers do in order to achieve a “look.” Society will give up everything for aesthetic, and its so sad that we get pulled into this whirlpool of self-worth being connected to numbers on scales or the reflection in the mirror. Type in “how to” into Google and you get the suggestion: “How to be anorexic.” Perhaps a year or so ago I would have clicked on this, like so many insecure people in pursuit of confidence in their physical selves as a means to attain inner-confidence, when confidence is the last thing anorexia gives you.
People who haven’t suffered from this illness will have trouble grasping that this isn’t about weight and food at all (that’s the result, not the cause), and furthermore that it isn’t a choice. I got it without wanting it, and it took me to hospital and psychiatric wards and back to realise something important that the world never teaches enough. Firstly: skinny isn’t all it’s made out to be. I was turned down jobs, told to eat a bigger breakfast from strangers, and even had someone spit at me when she drove past, yelling “EAT SOMETHING.” I broke down and cried, a heap of bones on the sidewalk, wanting nothing but to be accepted.
Secondly: Measurements, food-management, exercise or anything that’s abused to create a physical manifestation of how fragile you may feel inside (cuts, muscles, bones—take your pick); they’re not adequate means of finding content in oneself, nor is it a coping mechanism that delivers lasting comfort or sense of control. In fact, comfort and control are what it takes away from you, amongst countless other things. Achieving something physically does not awaken a self-contentedness that you never developed previously. If you don’t feel happy within yourself NOW, that’s the issue that needs dealing with, because trying to reinvent yourself physically or how you appear socially, is a separate matter—you’ll still be the same unhappy person on the inside.
I learnt that the hard way. Anorexia persists because whilst you still have variables in your life that can be more restricted and controlled, there is still hope in personal perfection. Perfection = supposed peace.
But in reality there are no montages, no gallant orchestra soundtracks, or video-edited camera pans that magically come together and form this moment when perfection is reached, to make you feel confident and strong. So you keep going, and going, and the mindset becomes exponentially perverted and deceived from the malnourished state of your brain, so that you lose sight of everything else. I did. All because I couldn’t deal with insecurity and because I lacked the resilience to tackle the everyday obstacles that life catapulted towards me. I couldn’t muster the courage to do anything but determine my worth by how people treated/mistreated me, what they said/didn’t say about me, when everything could have been different if I had learnt that your worth is only determined by YOU. That is the only steadfast sense of self-worth that remains a lifetime; mere comments that people say from day to day will change like the wind, and will leave you feeling like you have no concrete identity. But it’s there.
All of this may seem so commonsensical to you, as it does me now, but recognising logic when you currently reside in rigid illogicality of thought, doesn’t mean you are able to stop your ill outlook and behaviours. I can empathise with the mentally non-affected in this way, because I too was like you. I’d seen all the psychiatric ward documentaries and had not understood how they couldn’t simply fix themselves—that mental illness was not just people not wanting to change how they felt and making everyone else have to deal with them. But it’s REAL. What a terrifying revelation it has been for me.
I knew throughout my anorexia that I had a serious problem. I knew what I was doing was wrong, but at the same time it seemed so REAL to me, and I forgotten how to live any different. It made so much sense because over time, I’d biologically rewired my neurological pathways so that my body could run on the lack of food and excessive exercise I was doing, accommodating a thought pattern that pervertedly makes sense of defying life’s basic instinct: to eat and LIVE. That’s why anorexia is an extremely nature-defying problem, and why you can’t just “stop” when you want to, because your brain is physically not the same one you had before. And society often embraces its mindset.
I got onto various extreme diets during my problem; raw foodism, veganism, gluten-free-ism for the non-gluten-intolerant, etc. and I was championed for it. I never knew I had anorexia until it was too late, because my friends, family, every magazine to date, were praising me for having “so much self-control,” when many of these diets are actually used as a disguise for socially-accepted eating disorders. I wasn’t doing it “for the animals,” “for the environment,” or even why I thought I was doing it: “to be the healthiest person I can be.” It was for control, and it never gave me that.
Anorexia is the biggest killer out of all mental illnesses (20% die). Even though I’m still alive, I’ve lost friends, bone density, muscle-mass, the ability to have children (temporarily, hopefully), have scars on my wrists, have bald patches on my head, been in lock-down rooms on suicide-watch, had parkinson/epileptic-looking panic-attacks, and wasted my high school years to insecurity—with the cherry-on-top: a whole year of anorexia and suicidal pre-occupation.
All of this happens, around the world, all the time. On and on. In silence. With a false smile to hide the pain. I’m sick of my poor friends having cuts on their arms. Of primary schoolers throwing up their meals. Of people praising others who have lost weight when they were healthy before. Of guys enslaving themselves at the gym because they feel “puny.” Of hearing stories like several of my friends having been raped by their fathers and relatives when they were a child (the ward I went to is a very, sad place) and being forever shaken from the aftermath. I’m sick of people saying to depressed people: “just be happy” and to those with eating disorders: “why don’t you just EAT?”
Try telling a cancer patient to cure themselves, and you’ll see how helpful statements like that are. I’m sick of boys having to act like emotionless statues at school to fit in, only to cry silently in their beds at night, wanting to disappear. I know, because I hear their stories. I’ve held them when they cried.
No matter if you are heterosexual, homosexual, a schizophrenic intellectual. A white man, brown girl, green, blue, purple or black, an LSD-tripping insomniac. If you’re an anorexic perfectionist, an OCD receptionist, suicidal atheist, an alcoholic therapist—Yes, okay, I’m not going to feature in an Eminem album. What I mean is, it doesn’t matter who you are or where you come from; you ALL have a voice and a story, and you are entitled to feel not okay. We’re only human: and society has to stop teaching us that we shouldn’t possess things that make us a member of our species, having to shove all the emotional baggage, all our unique traits, in the cupboard under the stairs like they’re Harry Potter hiding from the Dursley’s. It shouldn’t have to be this way.
Please, if you’re suffering, seek help. You deserve happiness. Recovery is possible; take it from someone who thought it wasn’t. If you are suffering from an eating disorder, depression, anxiety, whatever it is you carry on your shoulders, it’s okay to lean on those around us for support. If you are a parent/friend/family member looking for someone with personal insight into any of the above-mentioned issues, please don’t hesitate to contact me or leave me a question.
Remember: you are not a college admission rank, a statistic, a grade, a measurement, the number of friends you have, the amount of boys/girls who like you, the classes you’re good at, what you eat, the compliments you receive, the criticisms that come your way, nor are you the things you do or fail to do. NOTHING can encompass all that you are, and when you try to fit into these types of categories, or determine your worth by them, you’re reducing yourself. You’re so much more.
Lauren now has a regular blog on Mom Psych: Please follow her on Inside Anorexia.
My email is email@example.com should you wish to contact me. I hope I can be of any help I can
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Excellent! Vividly told, detailed, expressive – I very much enjoyed reading this account. I’m grateful you took the time to write it, and I do know that a piece of this size takes real time to write. This is simply compelling writing.
As a psychotherapist, I would only wish to add that we do have intervention strategies that usually work with eating disorders, although like many serious disorders they are not “magic pills”. That should surprise no one.
I would also add that while this particular disorder invariably has organic aspects which require medical management (although the evidence that it is organically caused is essentially non-existent), it is fundamentally a psychological disorder and must be dealt with by a psychological specialist. There are crucial affect management, cognitive, and often familial issues to be addressed and resolved. Doctors and hospitals don’t do this sort of work – psychotherapists do.
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Thank you for sharing your passion for people who are suffering, and to tell your story to help those who wouldn’t otherwise understand. What is the most helpful thing people can do / say to teens they are concerned about to start a dialogue? I agree, there are too many sad people who are struggling, and I would hate to do or say anything that would only exacerbate the problem.
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Hi Rachel! Thank-you so much for responding, and I hope something I have said has resonated with you. Forgive me but I’m battling to decipher your question. Do you mean “what is the most helpful thing people can do or say to teenagers regarding their generation’s issues in order to spark a global conversation?”
If that’s your question, and it is a good one, it’s very hard to answer. I personally believe that the best way to approach it is by a more widespread critical reevaluation of society’s trends, tendencies and values via the very thing that initiates them: the media. Such a harmfully influential tool is also capable of noble deeds and impact should the people behind it be less inclined to target people by harping on their insecurities and silencing the “individual” and their existential struggle. Instead, a public criticism of what takes the world by craze should be encouraged in everyday discourse. Why is this popular? What does it do for us? Is it benefitting our wellbeing in the long-run? Who does it privilege? What does it silence? Is it a marketing strategy?
How can this be done? I believe that mental illness, insecurities and unhappiness is often not necessarily CAUSED by media, but certainly encourages the continuance of these problems and forcing it to occur behind the scenes. As teenagers are less-inclined to listen to adults and their pearls of wisdom, as the generational gap can make its relevance ill-suited to the current context, I think that teenagers themselves have a responsibility to dictate trends, attitudes and values. Newspapers could be of help, but yet again, the teenage voice is written from the primary source of an adult journalist, whom hasn’t lived in the pubescent world of around 2014. If teens were part of official news like these, it would get to both parent and child, creating a familial understanding and awareness. Who better to speak out than those that have suffered from it in the extreme? They have credibility and believable insight, because they’ve experienced “____” down to a T.
Example: I can speak out against current trends like “thinspiration,” “fit-spiration,” “health-spiration” —all of which are a craze on social media—as well as this global obsession with weight-loss and condemnation of weight gain, let alone the social fixation on appearance (shopping for makeup, clothes, accessories to enhance physical appearance are one of the only activities that females practice together) etc. because I have taken all of these to the extremes. I went to incredibly “skinny,” “fad-dieter-and-thus-supposedly-healthier-than-thou,” “fit”—all these ideals—and back to realise none of it is the answer, and that it’s not a healthy relationship for one to have with food, exercise, their body’s, or furthermore themselves. It never gave me all the things that people, marketers, the media, promise it delivers. I can teach this to people through my own personal journey.
Similarly, people with things such as suicidal preoccupation etc, can talk about the widespread mutuality of their condition despite its lack of disclosure and acceptance, and how it’s harmful and a ridiculous self-destructive social tendency. The list is endless.
It is not so much what adults can do or say to help generate this dialogue, but more what they can encourage and ALLOW. Eg: my parents were terrified of me talking about my condition online in fear that I wouldn’t be employed because of it. I don’t want to be on a planet that wouldn’t hire me because I have been human: insecure, confused, and vulnerable. Allowing teenagers to know that they really do have a voice in this world; that they can cast a vote in regards to what type of world they want to live in, purely by talking, networking, and being open about their own humanity and the feelings that accompany it… it’s so important. There is no better way to moving a teenager to understand than another understanding, articulate and insightful teen.
I will soon write up more articles about how parents can approach, understand an assist their child during depression and eating disorders. I’ll also describe in detail how the anorexic, the anxious, and the depressed tends to think based on my own experiences, and how to help someone, not their mental illness. And there is a HUGE difference. If there is anything you’d like me to cover in this, please leave me questions 🙂
Your fellow human,
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Note to Tom Cloyd: regarding the idea that “evidence that (anorexia) is organically caused is essentially non-existent,” it may interest you to know NIMH funded studies conducted in the last 10-15 have established strong evidence of a genetic foundation for anorexia and other eating disorders. Among the therapists that I’ve encountered that specialize in eating disorders–that would be a fair number–the notion of genetic/neurological predisposition to these conditions is pretty much a given.
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Gomer: Given the fact of genetic variability at the individual level, if one looks for a genetic predisposition for a given disease one will virtual always be found. So what? This is relevant ONLY (a) at the level of a public health (population level) intervention, or (b) at the individual level one has a genetic level intervention that is validated, safe, and powerful enough actually matter. For anorexia, to my best knowledge, we have no such interventions at either level.
Biochemistry and genetics have the glitter of “real science”, but have given us very little to work with in mental illness, outside of a few diagnostic categories. To the extent that we are dealing with learned responses (e.g., PTSD, or most depression, etc.), this will always be the case. Doubtful? OK, then go to work developing a calculus pill, or a pill I can take which will turn me into a professional level bike racer. This is a thinking error many who live in “wet labs” persist in making, to no good effect. They have a lot of company in the general public. Anorexia is clearly primarily an anxiety disorder, and one learns one’s way out of it. The idea of an anorexia pill, or surgical procedure, doesn’t border on the absurd; it IS absurd.
Panic disorder is a special case of real interest. It is clearly organic in origin, but we have no organic treatments. Instead, we do have a psychotherapy intervention with a high success rate, and it is totally about learning! (I have used this intervention with a client, myself, with outstanding success.)
One thought: I wouldn’t assume that all interest in genetic predispositions is connected to the hope that a pill can be developed. The fact that there is complex interplay between nature and nurture in mental disorders is fairly well understood, even if the specific mechanics aren’t. Even psychotherapy treatments can be improved by the knowledge that there are genetic predispositions, right? For instance, it can be very comforting to a client to know that there is a genetic component . . . and helpful for friends and family to understand–in effect, reducing stigma. As a trauma expert, you certainly remember (without fondness) that there was a time when those suffering the effects of wartime trauma were thought to be exhibiting weak character, or cowardice. I think looking for genetic predispositions is relevant to much more than simply the potential for medical intervention.
Gina – I agree with your concluding sentence. AND with the idea that being able to promote a fact-based model of a disorder (which may include genetic aspects of etiology) can facilitate both treatment at the individual level and a reduction of stigma at the group (e.g., familial) or population level. You bet!
My concern is the reference to “causality” in Gomer’s original remark. At the individual level, a genetic predisposition (GP) is NOT a variable, and therefore cannot be a cause. Only things that vary can be a cause. Given a GP, it is NOT determined that a disorder will develop; that’s why it’s called a ‘predisposition”, of course. What is determinant is other factors which are NOT genetic.
If someone walks into my office with anorexia, has a complaint about this, and wants an intervention, it is pointless to give attention to genetics, other than (assuming genetics really ARE a significant population level factor) to assist said individual in correcting framing what’s happening to them. As previously stated, genetic-level interventions for mental illness are, to my knowledge, nonexistent.
My view is surely conditioned by the fact that I’m a front line interventionist. I work to eliminate or reduce dis-eases. So, for example, if someone is properly diagnosed as having a bi-polar or related disorder, I know two useful things: We likely can find a useful pharmaceutical intervention (using a specialist in such matters) AND we will need to give attention to actual behavior, because while behavior doesn’t cause bi-polar d/o, it sure can cause its persistence. A disturbing proportion of bi-polars resist or discontinue their prescribed medication at some point, with predictable results. So, looking just at this very “organic” disorder, it is clear that if all we see is the purported organic cause, our treatment results will not be nearly as good compared to what happens if we factor in a behavior aspect, relative to the question of outcomes.
So, with the example of bi-polar, what is causal relative to where you will be in 5 years is both organic and behavioral. To say this is good, evidence-based, causal modeling, and that’s precisely the kind I’m interested in. This approach has immediate applications to the example of anorexia. If Lauren want help, it will not be coming from genetics. It’s that simple.
Tom–I get the feeling you’re over-thinking a bit here. My response was to the contention that there was no evidence for an organic (read: biological as opposed to strictly psychological) basis for AN and other eating disorders. In establishing a genetic link, the studies I mention necessarily provide that evidence. Last time I checked, biochemistry and genetics were, in fact, real sciences in spite of the fact that they may not (at this point in time) play a direct role in treatments. Quantum physics is a real science despite the fact that is is difficult to incorporate the existence of non-locality and wave function into a trip to the supermarket.
The causal impact of a predisposition is certainly clear to those who end up with whatever condition they are predisposed to insofar as the absence of the predisposition would have prevented the condition from developing just as much as the absence of the trigger. Both heat and gasoline can, collectively, be considered to be the cause of a fire, even if neither can produce it alone. Many people who have identified a familial (read: genetic) predisposition for cancer can and do seek treatment to prevent that predisposition from manifesting itself.
Some of the studies, if you read them, do make direct reference to how the research might lead to the development of pharmacological treatments and remedies for eating disorders. The 21st Century is shaping up to be the century when genetics comes into its own.
This, of course, is not to be dismissive of the behavioral treatments you recommend which are both efficacious and very much needed to help the people struggling with these disorders.
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Gomer – overthinking? I doubt it. Where? Formal causal analysis is a long-term interest of mine. It follows from that that I will be more analytical in discussing causality than many others. Where’s the problem? I see none.
You make some good points, and I have no trouble giving you credit. However…
I certainly never said that genetics was irrelevant; in fact I said it surely was – the question is “how much?” (see final paragraph, below).
“The causal impact of a predisposition is certainly clear to those who end up with whatever condition they are predisposed to…” I doubt it. Few of them are likely either to know about predisposing factors OR whether or not they have bearing in their particular case.
It certainly is possible that an intervention addressing a predisposing factor(s) might be developed AND that it might be curative. Consider ebola: the current best intervention is to support basic organic systems while the patient’s immune system organizes a response to the virus and then eradicates it. This works. It’s also not the intervention of choice, which would be something that addresses the virus directly – and we don’t yet have that.
My concerns in the beginning of this discussion were fundamentally two-fold:
1. To address the current cultural favoritism given to the fundamental logical error of reductionism. This occurs when a learning problem (such as a trauma disorder, or cognitively-based depression or anxiety) is considered reducible and treatable as an organic disease. With adequate understanding of the disorders and issues, this proposition becomes absurd on its face. My reference to a “calculus pill” was an attempt to make this error baldly obvious to those unfamiliar with it. To the extent that anorexia is NOT primarily caused by genetics, this point matters.
2. To question the value of discussing organic causes of anorexia when (a) the effect size of this factor in the causal equation is unstated (and to me unknown), and (b) we have no actual organic intervention available or even in sight. This is a purely practical consideration, likely to matter only to anorexics and their therapists and physicians.
So, at this point, for me, there is one simple question to be answered (and I do not have the time to pursue this myself, as I am preparing to move my household AND trying to launch a complex website, all in November!): What do we presently know about the actual VALUE of the genetic factor(s) in the anorexia causal equation? Has an effect size statistics (R-squared or Cohen’s D, for example) been presented in any of the studies? Can it be computed from the data presented in research reports?
Suppose that all anorexics have some predisposing genetic factor, but that in the group of those who have that factor only 10% ever develop the disease. Without any calculations, it should be obvious that the predictive (i.e. causal) value of genetics is minor, at best.
So, having framed the question, I do wonder what the answer might be, to the best of our knowledge. Personally, I have no idea, but I do strongly suspect that if anorexia were predominantly a genetic disease, we’d all have already heard about it, and we haven’t.