it takes a village

normally i work from home on a tuesday because i have therapy first thing in the morning and i generally need a bit of solo time after my sessions. apart from when i’ve run away, this has been the pattern for the last nine months or so.

today, however, i’m in the office because not only do i now have a new psychiatrist but i also will have a new therapist after tomorrow.

i’m very grateful to my now ex-therapist. without him, i wouldn’t have got through the crippling ptsd that i suffered for most of last year. but there were also things that frustrated me about him and i felt that our sessions – or at least the overarching theme of our sessions rather than the individual sessions themselves – lacked a structure or focus. and in the short time that i’ve been under my new psychiatrist’s care (is it really less than three weeks?!), i think it’s become clear that i need more intensive treatment than i’m currently getting.

i’ve had some success with bringing my calorie intake up but that has resulted in some other unhealthy behaviours rearing up. behaviours that i thought i had well and truly left behind including, but not limited to, one of the biggest and most shameful binges i’ve ever had last night. my new psychiatrist said that he’s still happy that i can be treated on an outpatient basis (even that sounds so serious) and i’m not at the stage of needing day patient / inpatient care. but he’s also made it clear that it’s probably only a matter of a few weeks and that continued outpatient support relies on me actively participating in my recovery and surrounding myself with the best possible people. he has pulled some strings to get me appointments both with one of the top nutritionists in london and with a highly recommended specialist in cbt-e. i know the rest is down to me.

and, as much as i hate to admit it because i like to think of myself as independent and resilient and self-sufficient and everything else that a seemingly professional and pulled-together woman in her mid-thirties should be, i’m not really any of those things. i need all the help that i can get at the moment. because i want to beat this. i really do. and i can’t do it by myself. this is going to have to be a team effort.

this week is eating disorder awareness week (#edaw2018). already i’ve seen so many inspiring tweets, blog posts, articles and vlogs from people who are suffering, have suffered or have watched someone suffer. inspired by all of those stories, i’ve gradually told more and more people in my life what’s been going on and have been staggered by the generosity of spirit that so many people have shown me. most people don’t really know how to react or what to say – which is absolutely fine with me – but just knowing that they’re there and cheering me on is enough for me.

it’s yet another one of those strange paradoxes that anorexia is built on; i don’t think i’ve ever felt so loved at a time when i’ve never hated myself more.

{title quotation from an african proverb}

the shared meal elevates eating…from mere animal biology to an act of culture

yesterday i ate a meal in public for this first time this year. a little under two months without eating in a restaurant or coffee shop or pub probably isn’t that big a deal in the grand scheme of things – i’m aware that plenty of people eat out far less than that and are perfectly happy with it – but it feels like a lifetime to me.

my psychiatrist asked me last week to make a list of the things that anorexia has given me and the things that it has taken away from me. the latter list is, of course, so much longer and i still have enough insight to appreciate that even the things that i think anorexia has given me (a sense of control, better regulation of my emotions, reduction in ptsd symptoms etc) are all an illusion really.

my eating disorder has taken, and is taking, so much away from me. the first and foremost is obviously starting ivf but, beyond that, it has insidiously seeped into every aspect of my day-to-day life, even if i don’t always realise it. one of the most sobering things that my psychiatrist said to me this week was actually something said in passing – that he’d have to swap rooms for my appointment with him next week because his usual room is right at the top of a tall victorian building just off harley street without a lift and he didn’t want me walking up that many stairs. someone telling me that i’m too ill to climb up four flights of stairs? that hit home like nothing else has. (even if i do think it’s a complete overreaction, not least as i live in a third floor flat and still always take the stairs.)

clearly, anorexia is also having a huge impact on my social life and all of my relationships. i’ve had to come up with an increasingly elaborate series of excuses as to why i can’t go somewhere or, if i do, why i have to leave early and/or not eat or drink. it’s exhausting. so much of what i use to enjoy resolved around eating and drinking with my husband or family or friends and that part of my life just feels so alien to me right now. eating solo is all well and good but very little can beat that magic of sharing a meal with people that i love.

and so, when my mother suggested that we meet up on saturday morning for a spot of shopping and some lunch, my initial reaction was to decline and cite some mythical prior commitment. but i need to start challenging myself and pushing myself and gaining weight otherwise everything else is pointless. so i booked a table at one of my favourite places to eat, studied the menu online for far longer than is normal and decided that i was going to fight for it. and i did.

i got there early and ordered a blood orange tea (i’m not really a tea drinker but i was bloody freezing). when my mum arrived, we ordered our food and i allowed the conversation to distract me enough to eat most of the delicious shakshuka that i ordered. and nothing bad happened. my parents don’t actually know about the anorexia diagnosis although clearly they can see that i’ve lost a lot of weight. my mother twice made reference to anorexia in different contexts (once in relation to a friend of hers, once in relation to bone density…we really know how to have interesting brunch conversations) and part of me wonders if she was trying to give me an opening to admit it to her. if she was, i didn’t take it. i don’t know if i’ll ever be ready to tell her.

what we did discuss openly though was our plans for ivf (i made a couple of excuses as to why we haven’t started yet) and she, very generously, said that she and my dad would like to contribute to the costs once we get there. this was so overwhelmingly kind of them and i don’t think i’ll ever be able to thank them enough for easing the financial burden of treatment. what it does mean though is that i really do need to get better. the only thing standing in the way of our dreams now is my anorexia and i can’t have that any longer.

{title quotation from in defense of food: an eater’s manifesto by michael pollan}

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we’ll be counting stars

i like numbers. i’ve always liked numbers. i liked maths at school and, although i didn’t end up studying it at university, i chose a subject with a similar set of rules. you either get numbers or you don’t. there’s no judgement either way as far as i’m concerned but i’ve always considered myself lucky to be firmly in the numerical camp.

i like baking because i like numbers. again, i know this isn’t the same for everyone. but i love the precision and the rules (there they are again) and the magic that can be created from some simple ratios. the most traditional, of course, is the old favourite of the 4-4-4-2 sponge which i don’t think can ever really be beaten for pure magic. but there are hundreds of other ratios that i use every time that i bake and a little too much one way or the other will normally result in catastrophe (or, at least, a slightly flat cake which, depending on how dramatic i’m feeling, might well be a catastrophe).

my anorexia (i’m still trying to get used to calling it that) is dominated by numbers too.

1. how much do i weigh?
2. how many times have i weighed myself that day?
3. how much weight have i gained or lost since the day before?
4. since the week before?
5. since the month before?
6. how much does each ingredient of my dinner weight?
7. how many calories have i consumed in total?
8. how many calories have i burnt through exercise?
9. how many glasses of water have i drunk?
10. how often have i been to the loo?

there are many, many more numbers that i track on a daily basis, even if just subconsciously. in order to recover, some of these need to go up and some of these need to go down.

letting go of the numbers is going to be one of the hardest parts for me i think.

i tried to explain to my therapist this morning that my issues around needing to control my weight are far more about having control of that number than about my size or how i look. the latter two concepts are so fluid and nebulous. my weight is piece of hard evidence that i can use to demonstrate that i’m in charge of my life. i don’t think he really got it.

on the way home, i spent a long time wondering around waitrose, trying to decide what to have for lunch and was uninspired. i’ve never really been very good at working out what to cook when it’s just me at home. for that very reason, i’d bought signe johansen’s book ‘solo: the joy of cooking for one‘ on a whim the other day.  before anorexia, i would default to a bowl of pasta. these days, i’m lucky if it’s anything. the first recipe that i’ve tried isn’t technically a recipe for one i guess but it’s one that i hope will form the basis of many more solo meals to come; a simple seeded multigrain soda bread. it couldn’t really be easier – a mix of spelt, wholewheat flour, oats and seeds all squished together with buttermilk and a little treacle. cocoa powder gives it a beautiful brown colour and trusty bicarbonate of soda gives it a rise. i threw in double the amount of salt required and a handful of chopped rosemary from our just-about-surviving plant. i topped my first slice with some roasted cherry tomatoes, a few crumbles of goat’s cheese and a sprinkling of fresh basil. utterly delicious.

my doctor says i need to be eating at least 500 calories a day (although, it goes without saying that the more the better at the moment). i’m hoping today i’ll get there.

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and that sweet city with her dreaming spires

i went to oxford this week. although i’ve been there a few times (and, come to think of it, worked on a project there for a couple of months), it’s not a city i know well at all. i went to the other place and, when i was choosing universities, i never really considered oxford. i don’t know why. it’s not like my heart was set on cambridge at all.

i had a pretty miserable time at university. i didn’t mind the work and wish i’d spent more time taking advantage of the academic opportunities but i wasn’t really happy. part of that was down to what, with the benefit of hindsight, i know see was a very emotionally abusive relationship. part of it was down to the claustrophobic nature of cambridge itself. part of it was that i just missed feeling at home somewhere. i never felt at home in cambridge and i’ve realised, particularly over the last few months, how much i need that feeling of security and safety.

it was also the place where i first suffered from anorexia even if i didn’t know or acknowledge it at the time. to me, it was all just part of the madness of those years. disordered eating habits had been part of my life for longer – since my early teens really – but university was really the time when this pattern of trying to control the uncontrollable really kicked in.

so, it was weird being in oxford this week. so many of the buildings look so familiar to those in cambridge that it felt like i was back there and the world had just tilted a little. i was in oxford to take part in an academic study on how women with and without eating disorders perceive bodies (both their own and other people’s). it involved several computer based tests which would be almost impossible to describe and i deliberately didn’t think too hard about what the tests were trying to show so that i didn’t mess up the study at all. it also involved an interview with a psychiatrist and going through the eating disorder examination questionnaire. i’ve never officially done this before (my old psychiatrist didn’t seem fussed by my eating disorder; my new one prefers just to discuss things rather than fill in questionnaires).

whilst i am partial to an online test and have probably done thousands of ‘do you have an eating disorder?’ tests in the past, even i was surprised at my responses and how strongly i scored on the anorexia scale. i answered ‘every day’ or ‘markedly’ to every question whether it was how often i restricted my food and how frequently thinking about food meant that i couldn’t concentrate or whether it was how guilty i felt about eating or how i judged myself on my weight.

i said to my psychiatrist this week that i don’t think i’ve grasped yet that i have a problem. i think i’m beginning to do so.

{title quotation from thyrsis by matthew arnold}

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to reawaken us, to shake us from our lethargy

today is pancake day. the day to feast before 40 days of restriction.

except 1) i am not religious and 2) every day is a day of restriction here.

no such caveats apply to my husband though and he has been mulling what to give up for lent. i suggested alcohol but, as he has just successfully completed a dry january, that didn’t seem much of a challenge. last year, he gave up all processed/added sugar and he was considering doing that again. he did pizza one year but has vowed never again. normally i join him in whatever he gives up, more for moral support than any other reason.

it’s been strange since i told him last week of my anorexia diagnosis. once he got over his initial confusion (‘is that the one where you throw up?’), he said he was sad. and that makes me so sad.

i can tell that he doesn’t know what to do or to say. this morning in bed, he had his arms around me and i could tell that he was feeling the bones which have gradually become frighteningly close to the surface. but i could also tell that he didn’t know what to say. we’ve had more arguments in this past week than we’ve had for the whole of our relationship, generally because he’s tried to make me eat something that i don’t want or – more often – can’t bring myself to eat. as much as i might be struggling right now, i think it’s even worse for him.

this morning, i emailed today’s weight to my psychiatrist. i’ve lost even more. his reply was stark. i’m heading for a hospital admission within a month. that’s not what he wants for me and that’s definitely not what i want for myself. i can’t even begin to imagine how it would devastate my husband. in order to avoid that, my psychiatrist has said we need a more ‘aggressive’ approach. i don’t know quite what that entails yet but i know it’s going to be fucking hard.

when i asked my husband earlier what he’d decided to give up and he said he’d decided not to give anything up. i think that’s his sacrifice for me; the last thing i need is more restriction in my life.

by the time lent finishes, on 1 april, i would love to have our first round of ivf underway. i’m not sure that’s a realistic proposition any more given where i am today but i have to believe that, 40 days from tomorrow, i’ll be in a much better place.

oh and whilst i can’t face our normal shrove tuesday pancakes, drowning in lemon juice and crisp with sugar, i’m not a total heathen so i’m planning a version of these alongside my latest obsession, broccoli roasted with garlic and a scattering of chilli flakes.

{title quotation from pope francis at the start of lent in 2014}

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the beginning is always today

i’ve just eaten lunch.

i can count on one hand the number of times i’ve eaten lunch in the last six months. the last time i ate lunch was on 1 january when we went to visit some friends and i couldn’t really think of an excuse not to go (not least as i’ve been so self involved recently that i’ve been a terrible friend).

a lot has happened this week. on tuesday, i agreed with my therapist that the advice from the nutritionist i saw was both unhelpful and dangerous. he also was happy for me to not go back to the psychiatrist i’ve been seeing since september so long as i found an alternative and, preferably, one that had a slightly more than basic understanding of eating disorders. i emailed both the nutritionist and psychiatrist later that day. my psychiatrist’s pa confirmed that my next appointment had been cancelled and that’s the only follow up i’ve had from either of them. i’m slightly staggered that, given the psychiatrist claimed to be very concerned about me a few weeks ago, she hasn’t bothered to get in touch. at least it allows me to draw a line under both of them and move forward.

by thursday, i’d found a new psychiatrist and had an initial appointment. he changed some of the aspsects of my diagnosis (it’s now formally anorexia nervosa rather than the hodge podge it was before), tweaked some of my medications and, before my session had even finished, emailed me a ‘day 1’ plan.

yesterday was day 1.

day 1 involved eating breakfast which i haven’t done for a very long time. it was a struggle but i managed to eat some plain yoghurt. it also involved telling my husband the truth about my diagnosis which i somehow managed to do. and there, in black and white, is my acklowledgement that ivf and having a baby is more important to me than having an eating disorder. i’m still trying to make myself believe that this is true.

day 1 also involved telling my boss at work what was going on. i thought it would be a shock to him. unfortunately, it wasn’t and before i even said anything about eating disorders, he told me that a number of people had expressed concerns to him about my weight loss.

having it out there in the open does feel better. the more people that know, the more people there are to let down and the more i have to recover.  having a definitive plan with targets and all the support i could want to get there feels better. my psychiatrist has said he will be in daily contact with me for the moment while we get through this ‘crisis’ (ie that i’m steadily losing weight). at the end of every day, i have to email him with my weight, what i’ve eaten and how i’ve felt throughout the day. it’s so far removed from the ‘help’ i’ve had previously (“go and see this quack nutritionist and then we’ll consider if you need to go to a residential clinic thousands of miles away which will pay me a nice referral bonus”).

it’s so unbelievably hard though and i really don’t think i can do it.

i left my session on thursday feeling really positive and strong but that’s waning, minute by minute. last night, i saw my dad who commented on my weight loss and ‘how well i was looking’. he doesn’t know about the eating disorder (still can’t bring myself to call it anorexia; i feel such a fraud having that diagnosis when i’m still so fat) and i’m sure he wouldn’t have said anything if he did. but all i can think about is how i have to keep losing weight and how great it felt this morning when i saw a more than acceptable drop on the scales from yesterday. and now i feel so full and bloated because i’ve already eaten twice today even though it amounts to <250 calories and was nothing more than yoghurt, a piece of sourdough bread and some fruit/veggies. the actual eating was less of a struggle than i anticipated. but just knowing how much i’ve eaten and seeing it written down and feeling it just sitting in my stomach is so much worse. the anxiety and panic is slowly rising up and threatening to consume me.

i bought this bracelet a few days ago. the rings represent my husband, me and the reason that i’m doing this. i need to focus on that with all my strength if the beginning really is going to be today.

{title quotation attributed to mary shelley}

every meal would be like saying grace

this week, i saw a nutritionist. i was wary and i was right to be.

i paid £150 to be told, firstly, that i was eating all the right things and that my diet was very healthy. i don’t disagree with this per se but i was 100% honest in my food diary and it didn’t amount to more than a couple of hundred calories a day. nothing was said about this. that seems irresponsible to me.

secondly, instead of practical suggestions of how to eat more, i was left with a two page document filled with a mix of trendy wellness crazes and bad science. it told me to eat more turmeric (“why not try a delicious turmeric latte?”), have a shot of apple cider vinegar before eating and stick to ‘alkalinising’ foods. when someone has an eating disorder which, by its very nature, results in all sorts of arbitrary rules, i feel like the aim should be to try and encourage a more relaxed and healthy relationship with food rather than introducing yet more restrictions.

the second half of the ‘lifestyle’ plan was a list of different (and very expensive) supplements that i should take with a referral link to buy them and which, i presume, will result in a hefty commission payment to her.

a lot of what she said, i fundamentally disagree with being, as may be obvious from the title quotation, a true believer in the doctrine of michael pollan. (another, longer, quotation that i feel is relevant here is from in defence of food: an eater’s manifesto – if you’re concerned about your health, you should probably avoid products that make health claims. why? because a health claim on a food product is a strong indication it’s not really food, and food is what you want to eat). i know that i don’t eat enough and i want (i think) to eat more but i don’t want to get there by artificial shakes (which she tried to sell me on), faddy trends and stuff that isn’t actually food. i like food. i love food. i like the colours and flavours and textures. that’s what i desperately want to be able to eat. i have bigger problems than not having enough turmeric in my life (plus, i cook with turmeric all the time so i’m probably okay on that front. it’s just, you know, everything else).

i’m supposed to follow the ‘plan’ for the next 6 weeks and see if i feel better (how? i feel absolutely fine now). i’m not going to. i’ve forwarded her advice to my therapist, who i’m seeing on tuesday, and will discuss it with him then. fundamentally, i think her suggestions are wrong, not just for me but for anyone with an eating disorder. i think it’s actually quite dangerous. she is chasing me to make a follow up appointment. i won’t be. given that i was referred to this nutritionist by my psychiatrist, i’ve also got serious concerns around whether i need to get rid of her and find myself someone who can actually help. another thing to discuss with my therapist on tuesday (i get the sense he might agree with me; i don’t think there is much love lost between them…). i don’t know what the fall out will be of telling the nutritionist that i’m not going to see her again – i will take my therapist’s advice as to whether i am honest about the reasons why – and/or telling my psychiatrist that i’m not going to see either of them again but i’ll deal with it. more than anything, i need the right people around me now.

{title quotation from the omnivore’s dilemma: a natural history of four meals by michael pollan}