Good things come to those who wait

This recent post by my friend Sarah Ravin got me thinking. She writes:

Like many psychiatric illnesses, eating disorders are often characterized by periods of exacerbation and periods of remission – a general waxing and waning of symptoms at various times. Symptoms may or may not be present at any point in time, but the predisposition is life-long. Stress of any kind has the potential to trigger a setback or a relapse.

We all have stress in our lives. Some stress is unavoidable, some foreseeable, some self-imposed. We can’t really predict or control certain major life stressors, such as natural disasters, car accidents, or the death of a family member. But we can control some of life’s stress – we can decide whether and when to make certain major life changes.

It's something people didn't really explain to me when I was sick. I was discharged from IP and, while still underweight and basically a raving lunatic, encouraged to go back to school since "it would be good from me." I made it less than two weeks before my school told me to leave or I would be kicked out for being a danger to myself.

Barely holding a normal weight, I went off to grad school. I hung on by the skin of my teeth, since I didn't want to repeat a one year program. Instead of consolidating my recovery, I took a high pressure job. I lasted months instead of weeks, but still, the anxiety, depression, and anorexia caught up with me again.

Yet from the outside, most people judged me "ready." My weight was (what everyone thought was) "normal" and I could spin a good tale. Sometimes, I actively bullshitted people. Mostly, I really did believe I was ready. Patience is not my strong suit- never was, never will be.

The problem is how I was measuring "ready." If I compared how I was doing at the time to how I am at my sickest, I had made heaps of improvements. But if you measured "ready" by how able I was to cope with life when life went pear shaped, then you would have had a different measure. Weight and behavioral stability are important, yes. I'm not doubting that. But that's not the sole definition of "ready" to move on to more of life's challenges.

The biggest hurdle for me was learning how to ask for help, and seeing my ED as a problem rather than a solution to whatever other problems were in my life. I had to be knocked on my arrogant ass, again and again and again until I finally got it thatI could only fake recovery for so long before everyone would find out. I had to risk appearing marginally stupid in the beginning to keep from looking like a complete jackass several months later.

The other part that took me a really long time to understand was just how long it takes to build new neural pathways and new responses. I seriously underestimated that. We're apt to see one meal eaten without a meltdown as I'm cured! So how about that college thing? I needed to eat three meals and two snacks each and every day for several years before I could reliably do it on my own.

I suck at behavioral and cognitive flexibility. What this means is that as long as life is chugging along, I can do just fine. Low stress, and I might almost appear normal, even to seasoned observers. Stress and change and all of the other uncertainties that life brings, however, made all of that fly right out the window. Life does generally settle into a cadence after a period of stress, and it was easy to think that I would manage just fine. Except I really didn't. Stress and anxiety meant eating disorder behaviors in my brain, and disconnecting the two things took years for me. I still have trouble with it. I'm much better at catching it and halting it than I have ever been, but the connection is there and probably will always be there, lurking.

The moral of the story is this: recovery is stressful enough. You don't have anything to prove by trying to cure cancer or whatever while recovering from an eating disorder. Master recovery first. Once you do that, everything else will seem really easy.

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drstrangelove said...

Thank. You.

The last paragraph was exactly what I needed. I didn't finish college in the "normal" time frame due to being sick and am struggling with getting back into the swing because I feel like a failure/imposter/etc. that didn't do what she was supposed to. I need/ed to hear that. It's okay that I chose my health first, and it doesn't make me a failure.

nikkicookskale said...

It reassures me to hear you talk about how long it takes for new neural pathways and responses--thank you. It goes a long way to explaining why people struggling with eating disorders find it so difficult to change behaviors that they've repeatedly realized are harmful to them.
And, it just makes me feel better--like even though I too have made many many many steps forward, it's okay that I'm still working at this.

Anonymous said...

Like you, Carrie, I am acutely sensitive to stress. I always have been; long before I ever developed an ED.

I wish that people had understood me and my anorexia better when I was a child/teen. In my teen years I reached a 'safe' weight but was still underweight. I found change very different and was struggling a lot socially. In terms of academia, I did just great. Top grades at school meant that my tutors and my parents were pushing for me to have a great career. I felt very pressured and really didn't feel ready to go to university at age 18. But I was pushed into applying by my school and my father.

It is only in my 40s that I made huge lifestyle changes and stepped back from many of the things that pressured me. It made recovery from AN a heck of a lot easier. I totally resonated with Sarah Ravin's post. It made such sense.

Sam said...

Yep, done that. Last year of high school spent about 9 months in hospital and while the grades I had previously achieved allowed me to graduate, I was unable to go back to school and finish 'properly'. So why oh why did I think I could go to college immediately thereafter? "Oh", I said, "I'm looking after myself and only going part-time".

Back up a step, you've been unable to finish high school due to illness, you're bed bound and unable to read anything more complicated than a cereal box, and you think you can study at college?! You can imagine how it played out.

The kicker, I think, is setting yourself up for failure when you know you have a pathological fear of failure. It's self-reinforcing. Mind you, I probably would have considered myself a failure if I hadn't gone.

I still haven't worked out how to set myself up for success.

Cammy said...

SUCH an important lesson/message that really is not discussed enough.

hm said...

It is difficult to set life aside though, and focus on recovery- especially if you're a full-on adult and life is in full swing. I cannot set aside being a wife, a mother, a teacher. I can't. My husband says I work too hard, and it worries him, but it is my work that pays for therapy/dietitian etc. so that we don't have to take it out of his paycheck. Sometimes you're stuck being busy and trying to recover at the same time, and it sucks, but there's nothing for it except to keep trying.

I am interested in the cycle you mentioned where you "fake" recovery until you crash- that feels like a topic that could use more discussion. I find myself in that rut over and over again- all smiles, everything's fine, I'm meeting my meal plan- while inside I'm falling apart and every meal or snack I skimp on (or skip altogether) makes me feel so ashamed that I just CANNOT tell anyone- I can't admit that I'm failing yet AGAIN- I keep thinking, it's not truly a failure if I can yank myself back up on my own WITHOUT telling anyone- but that never seems to work- the failures pile up and pile up until I feel like such the absolute jackass and am even MORE ashamed b/c by then, to admit my failure, I'd also have to admit I'm a total fucking liar and have been for months.

It's awful- and very isolating. I wonder if there is a better way.

But it also seems so selfish to be whining "I'm struuuuugling! Waaah!" all the freaking time to the people I love. Life is so much more pleasant for them and for me if I just smile and act ok.

Abby said...

"The biggest hurdle for me was learning how to ask for help, and seeing my ED as a problem rather than a solution to whatever other problems were in my life."

Yes. This. I get by under the notion that if I'm handling things "just fine," that there's no need to change my behavior. When in fact, surviving is far from thriving. I could go on, but I'm still at that point and this post really, really spoke to me. Thank you.

Em said...

Thank you.

I'm trying to find a job, find someone to live and get my life back together after divorce I've put all of these before recovery. A close friend has said to me on a couple of occasions that recovery needs to come before everything else. I didn't really consider she was right but after reading this maybe she is.

Although I will struggle to put recovery first as I'll feel far too guilty.

C-Girl said...

you have no idea how much my ears needed to hear this. recovery is more of a full-time job than i EVER want… and I have found it impossible to do recovery and everything else…I though one meal would change it, I thought things would be easier a month after I began therapy… it wasn't. It has gotten harder and harder and the truth is, it probably will only get harder. That's why putting everything else on hold is so necessary, and yet so difficult because it eliminates distractions and excuses. I really needed this reminder today… thank you.

A:) said...

I have to disagree Carrie, although I realize I am something of an anomaly.

I have had AN for 8 years now and developed it at 15 (though I would currently be classified as having AN in partial remission).

I took a year off for treatment after high school and gained 25lbs to a healthy BMI of 20.5 -- However, this did not stick and I was asked to leave the treatment program I had participated in for 7 months (though I continued with outpatient treatment).

After 5 months of this dismissal from the treatment program and about 3 weeks before I was ready to leave for university, I was in a desperate place -- I had a BMI of 14.5 and was on a wait list for inpatient treatment with the same hospital. However, I desperately wanted to go to university and stop my weight loss (though at that point I didn't have much interest in gaining weight).

I began to see a ED dietician, in addition to the ED-specialized psychiatrist and psychologist who had followed me for approximately 3 years. I entered first year university (though my team and parents did not have much hope in me finishing first year in such a horrible state) and found that I desperately wanted to stay.

In the first week of my classes I fell in love with university and decided I wanted to stay in this place that was devoted to learning and research -- and that I would do anything to stay. I realized that I did not have the stamina or mental health to undertake a university degree. I realized that weight gain was the key to this -- and in this way, I choice my mind over my body.

The next three years were filled with tears, severe panic attacks, asthma attacks, cutting and purging. During Frosh Week I learned that I had osteoporosis and had also developed re-feeding syndrome. . . However,I made my choice to stay at university (monitored by my medical team) and I will graduate next week. I am also top of my class.

I have started a PhD in psychiatry/neuro-imaging supervised by a prestigious supervisor at a top university in Canada. I have gained 27lbs since that dark time in first year.

I am not symptom free (purging, self-harm and over-exercise are still an issue) but my weight is in the healthy range and I can "pass" for normal. My dietician, psychiatrist and psychologist, who have been with me for these past 5 years are now helping to further my recovery. . .

I just wanted to remind everyone that all cases are individual. I have been in treatment three times and had the option to participate in treatment a fourth time. However, I wanted to try my hand in university -- and by doing this I rediscovered my passion for learning, which enabled me to fight back against my AN and (with support) slowly recover.


Anonymous said...

Really liked this post. I totally understand where you are coming from. I too have learnt the hard way.

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lwehr said...

I really needed to read this today. I have been doing this for the past 3 years. I go into treatment, reach a "normal" weight, bs some good answers to psych people, go home and struggle.

The first time I lasted a couple months, the second time 1 1/2 years, then only 4 weeks. It's been a year since my last stint and I am worse than I've ever been. I want to keep fighting it but I have barely made it through my master's program like this and I know I can't hang on for the duration of a doctoral degree that will come next. I still haven't convinced myself though that I should take the time and truly engage in the treatment experience. Logically I know that it would save my life and probably my career, brain is just plain screwed up.

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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nour·ish: (v); to sustain with food or nutriment; supply with what is necessary for life, health, and growth; to cherish, foster, keep alive; to strengthen, build up, or promote


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