I was in the bathroom today, and I got to thinking (thinking, for me, is generally a dangerous phenomenon and especially so when I have lots of time to myself, such as when using the loo).  Alcoholics can take Antabuse.  It doesn't take away the cravings or the ability to drink, it just makes drinking extremely unpleasant.  And I was thinking that it would be nice if I could have something like that for anorexia.  Something to make the illness immediately and acutely unpleasant.  Something to retrain my brain from thinking "But not eating will make me feel so much better..."

Of course, if an alcoholic really wanted to drink, they would just not take the Antabuse, but still.

I know that anorexia does make me feel worse in the long run.  But then I think that not eating will make me feel better right now, and it gets hard.  Because "long term" is very cognitive; "right now" is much more emotional.  It's much harder to use cognitive skills against a very visceral reaction.  It makes good evolutionary sense. When there's real danger, it's actually an asset to act without thinking.  The problem is that our brains generally suck at figuring out when it's real danger (as in OMG-I'm-going-to-be-eaten-by-a-tiger) and when it's not.  Again, thank natural selection.  It operates on whatever helps us survive and reproduce, not what makes our lives calm.

Which brings up the next question: maybe it's not my response (stress=ED thoughts), but my perception of danger.  The problem is that I find the world pretty terrifying.  And what do you do when you always feel on edge?  When you're never quite sure what will come back and bite you in the ass and so you treat everything like a rabid animal?

I think it's something I need to discuss with Dr. H tomorrow.  I know I need to desensitize myself to many of these things.  Exposure and response prevention is very effective with OCD, and I know personally that it's helped diminish my food fears.  But with the OCD and anorexia, I had something concrete to work on.  I was scared of germs.  Or food.  Or of hitting someone with my car.  Now, my problem isn't so much OCD but generalized anxiety, that constant "what if" chattering away in the back of my mind.

Anxiety can be overcome--or at least people can learn to live with it.  I'm still trying to figure out how.

First of all, thank you SO MUCH for the wonderful support.  I have the best readers, bar none, and I will seriously kick anyone's ass who says you aren't.

I've gotten emails and texts from quite a few people who have shared their own struggles. One comment I was particularly struck by was via Twitter (it was a private message, so no need to waste time looking!):

I lost a bit of weight recently and it's started up this annoying talk in my head. I hate how freaking pleased it makes part of me.

It's the last line in particular that really resonated.  It would be so much easier to fight off urges and behaviors if we found them seriously distressing.  The problem is that distressing is not always the word that comes to mind when ED behaviors return.  This summer, I did experience distress at the return of ED stuff, both while I was in Europe and then when my parents were away for a week or so.  Serious distress and only a little weight loss.  I remember being simultaneously puzzled and relieved at the distress--puzzled because it was something totally new, yet relieved that the distress meant I was extra motivated to address these issues.

Eventually, the ED stuff does get distressing.  Things like blue lips, anemia, and utter exhaustion ultimately take their toll.  For me, the notion that I wouldn't be able to keep working up to my usual capacity was a major motivator for me to take action.  For better or worse, my identity is very tied up with my career, and I take any threats to that very seriously.  I realize that I am more than just a writer, but that's also primarily how I think of myself. I don't have the security of disability or sick leave as a freelancer, and so if I can't work, I don't get paid.

Addressing a slip is generally much more stressful for me than the slip itself.  And therein lies the problem.  It's hard to change when you're not feeling any internal pressure to.  Of course, external pressure quickly stepped in and helped me move along, but still.  When I notice my depression increasing, I'm generally pretty motivated to do something about it (assuming I feel there's something that can be helped, but that's another story).  Same for the anxiety.  It's unpleasant.  The ED isn't always the same.  Staying in recovery would be so much easier if falling out of recovery was harder to deal with.

Usually, a mild relapse initially makes me feel better.  Hence the problem.

I think I need to start accepting that minor relapses aren't going to cause me any sort of distress and that I need to stop expecting distress to happen and relying on it to take action.  It's totally counter intuitive, but not much about EDs makes logical sense.  Why wouldn't a recurrence of a potentially deadly illness not stress me out?  I dunno.  Here's what I need to get through my thick skull: just because I'm not freaked out doesn't mean that it's not a big deal.


If that came naturally, my life would be so much easier, I think.

It's pretty much impossible to have missed the devastating earthquake, tsunami, and now nuclear meltdown in Japan.  Massive tragedies like this always throw me, because I think of how petty my concerns are in comparisons.

It's like realizing there are people who don't have food and housing makes me feel pretty shallow for fretting how many fat grams might be in my microwave popcorn.

Despite knowing the pettiness and shallowness, I still fret and these things still worry me.

I'm not trying to compare--because you really can't compare--and I'm not trying to make natural disasters all about ME ME ME as I've been accused in the past.  But it was helpful to hear the mom of a girl recovering from anorexia refer to the illness as her own personal tsunami.

Both are destructive.  Both require a lot of people to help clean up the mess, outside assistance, and things don't just return to normal once the massive clean-up crews return home.

This helped me to put things into perspective.  Not that global events aren't horrific, but so is an eating disorder.  It's a different kind of horror on a much different scale.  But measuring suffering is rather futile, and perhaps even more petty than fussing about fat in popcorn.  I get that a paper cut causes different suffering than losing an arm.  I get it.  I get that losing your house and your family is a hell of a lot worse than wondering if your low fat popcorn is actually the low fat stuff or if the packets might have gotten swapped in the open box and it's actually the stick of butter on each kernel kind.

But if that was the maximum amount of suffering caused by an eating disorder, I would welcome that suffering with open arms.  An eating disorder often seems superficial, as we crane our necks to make sure our asses haven't magically expanded after that extra bite of apple.  But there's a difference from the occasional "Do these jeans make my butt look fat?" and honest-to-goodness watching your thighs expand after eating a meal. Some of us howl and shriek about getting fat and food and calories and it sounds almost identical to the cultural hogwash we hear every day.  Maybe that's how we're translating something that's bizarre and inexplicable.  I don't know.

It's easy to feel guilty for thinking about EDs and recovery when there is so much legitimate suffering going on in the world.  I frequently do.  And yet my neglecting my recovery isn't going to help anyone.  Perhaps my suffering doesn't compare to what people in Japan are going through.  It probably doesn't.  But that doesn't mean that it's not suffering and that my eating disorder is simply excessive vanity.

When I moved into my new place last month, I splurged on cable.  I tried to justify it for any number of reasons (my other entertainment budget is nil, etc), but ultimately, I thought it would be kind of fun.  It didn't hurt that TV reception is pretty minimal without cable where I live.  So cable it is.

I used to be one of those "Oh, but I don't watch TV" people.  It started as a legitimate I-have-no-real-inclination-to-watch things.  When I was younger, I preferred reading.  Now that I'm older (and I spend all day reading and writing), I need to relax with less eye strain.  And I've gotten over my need to appear as a cool Intelligentista who is way the hell too cool to sit in front of the boob tube every night.

I thought eschewing TV made me hip and edgy.  It made me different from the stereotypical "fat, lazy American" that you read about in the papers.  It made me feel sort of better than.  I'm not the kind of person who would spend heaps of cash every month on something that just rots your brain!  There were plenty of times when, financially, forking out any extra money wasn't going to happen.  Not that my current budget has me rolling in the dough, but I can be careful and comfortable.

Here's the confession: I really like cable.  Every Saturday night is House reruns on Bravo (which is, as far as I can tell, the sole redeeming feature of that network).  I watched Bones reruns tonight on TNT.  I tuned in to a true crime marathon the other day, which was way too much fun. We all need a bit of smut, right?  I don't have DVR or Tivo--generally speaking, I'm around when a show airs, and if I like the program enough, I'll make an effort to watch it.  If it's not worth the effort, that I guess I'm not all that attached to the show.  If two shows ever aired at the same time, I would be in trouble, though.

It was something my eating disordered brain fought tooth and nail.  A chance to laze about!  Sit and do nothing! Become a couch potato!  Heavens, no!  Cable was banal and indulgent.

Well, maybe it is.  But it's also fun.  That's something I'm really starting to enjoy.

When I don't want to deal with something--ED or otherwise--I tend to avoid it.  I must confess that it is, occasionally, effective.  Sometimes people need to let their tempers cool off, and sometimes rebooting the computer really does fix everything.

Most of the time, it doesn't end up like this.

Usually, the scenario goes something like this:

Make a small mistake.  Feel embarrassed.  Avoid dealing with small mistake.  Small mistake festers into a big mistake.  Avoid dealing with that, too.  And so it goes until I spiral into a masterly cycle of self-hatred and despair.  In the midst of this self-hatred and despair, I never really deal with the actual problem: my avoidance.  Instead, I tell myself that the real problem is that I'm lazy, stupid, and a bad person.

Aside from the verbal self-flagellation, the litany of reasons I suck gives me an out.  Bad people do bad things.  Ergo, I have no real reason to push myself to stop.

It happens with the ED stuff (embarrassment at a small slip -> don't tell treatment team -> I'm a failure -> small slip becomes a big slip), and it happens in real life.  I never really listened to criticism and helpful feedback because in my mind, anything less than perfect was just an example of how crap a person I am.  I didn't listen because there really wasn't much point.

So I avoided even more.  Pulled away, hid from view--even when admitting my difficulties would have made the situation so much simpler.

An example: I was late on a deadline this past weekend.  Part of it was the chaos of moving, yes, but once I realized I was overdue, I resisted buckling down and attacking my job.  Plainly, I was mortified at my mistake.  I can be a space cadet at times, but generally I can keep things put together.  By going back to my work, I would have to admit to myself that I wasn't perfect, that I had royally screwed up.  So I put it off.  It was the weekend, and it wouldn't have mattered much anyway.

There was an element of truth to that.  But if I was being honest with myself--
If I cut the bullshit and really admitted to myself what was going on--
I was avoiding dealing with the problem.

A simple email to my editor saying "Oops, totally forgot in the moving chaos, I'll get something to you by Monday morning," would have essentially fixed everything.  Sending that email would mean I had to admit something was wrong.

I didn't want that.

I wanted to pretend it was all okay.

That wasn't okay.

The ED was a way for me to avoid so much of the crap that was going on in my life.  I didn't actually have to deal with it because I was focused instead on exercise, food, and weight.  When I was into the anorexia, I mentally checked out of life.  I didn't intend for that to happen, not really, but it fit my profile of dealing with things.

Avoid.
Ignore.
Smile through the tears.

Neither my reluctance to send an email nor the anorexia-driven avoidance really ever solved any problems.  I could pretend for a while.  Pretend that everything was fine, that it was no big deal, that I could manage everything.

This weekend reminded me that I couldn't.  My editor asked me to kindly send her an email when I was going to be late.  To be honest, I earned that. 

But this screw up allowed me to see another of anorexia's accidental functions.  I could connect the dots and see the patterns.  Avoidance.  I started to see the consequences, for once.

So I stepped out of that self-hate spiral and told myself: the only way to solve this problem is to get to work.  Not punish yourself with more exercise or less food or some other misadventure. I didn't need punishing, I needed to sit down and finish what I had started.

And so I did.

As one year begins its inevitable slide into another, I start thinking about another year with the ED, another year still not better.  Yes, I have made a lot of progress this year, but there is still far to travel.

I remember thinking after I had been ill for about a year that one whole year had passed without me eating or drinking anything without fear.  Actually, at the time, I thought of it as one whole year obsessing about eating.  I didn't see the fear/anxiety connection at that point.  I remember thinking that one year was quite a long time, but I also didn't see any way out.  It was tremendously disheartening and depressing (I was in the hospital at the time), but I thought that's just the way things were going to be.

It's been a decade since that moment.  It's been 11 years since I've eaten something without calculating calories or second-guessing whether I "should" or "shouldn't" eat it (yes, I do realize that I need to update my profile- I must have last updated it around two years ago).  My meal plan helps--the rules provide a necessary structure.  But I still frequently ask myself "Do I really need this slice of cheese, this pat of butter, this extra gob of peanut butter?"  I have to remind myself that yes, I do need this, even if I don't want it.

One of my old therapists told me that I should get mad at how much time the eating disorder has stolen from me.  I looked at her and I said: but I let it take this much time from me.  I can speak at length about the fact that eating disorders are illnesses, not choices, and I still can't shake the feeling that my suffering is my own fault.  That if I were smarter or less stubborn, I wouldn't have become anorexic in the first place or had as much trouble pulling myself out.  It's an odd disconnect.  I don't blame myself for my anxiety or depression, although I can't remember not being anxious and depressed.  I do remember there was a time before anorexia, although I have no idea what that was like.

I usually get all horribly introspective twice a year: on my birthday in July and around New Year's.  It's sort of the major landmarks of the passage of time in my life.  Winter, summer; age, year.  I'm not despairing about my recovery, but I do start to hyper-analyze things.  No, it doesn't usually help, but then, I don't do it to feel better.  I just feel compelled somehow to take stock of my life over the past year.

And 2010 has, on the whole, been pretty good to me.  I fought for that good.  I fought hard.  I quit my first job for reasons totally unrelated to the eating disorder--never done that before.  I either got sick or sacked first.  I bought a townhouse, I started a new career, and succeeded fairly well at that career.

Still, in the dark hours of the night, I feel irreparably broken.  That my life may never be normal.  That I may forget that it's possible to eat a meal without scrutinizing every crumb.  That, ultimately, I'm damaged goods.

But we're all damaged.  That's part of being human.  We all have our baggage and our semi-healed wounds.  Those wounds become scars that fade but never completely, and still we put one foot in front of the other and get on with things.

That's what I wish for you in 2011: the fading of hurts, the learning from pain, and the getting on with life.

I don't usually read news about celebrities, even when it does pertain to eating disorders. But by mistake, I clicked on a link about actress Portia De Generes, who has been in the news about her own eating disorder and subsequent memoir.  It was a very brief article--it covered a book signing--but there was one quote from Portia that really struck me:

I didn’t decide to become anorexic. It snuck up on me disguised as a healthy diet, a professional attitude. Being as thin as possible was a way to make the job of being an actress easier…

It's something I really understood.  I'm no actress, but being anorexic made it easier to be me.

Anorexia distilled all of those nagging doubt, those annoying existential worries, into just a few questions: How many calories did I eat? How many did I get rid of (exercise/purging)? What do I weigh?

That's it.  That's all that mattered.

I went through phases where other questions would branch off from those (How many fat grams? How many pills? How many hours without eating?) but those were The Big Three.

Worrying about my career choice seemed like small peanuts compared to thinking about how to construct a low calorie dinner followed by a brutal cardio routine.  It made life feel manageable.  Those three things were something I could control.*

Like Portia, I didn't decide to become anorexic.  I thought I was exercising more and cutting out extras to feel better and yes, have the five or so pounds I'd recently gained go away.  And I often hid my eating disorder behind the guise of a strange diet, a love of the gym, a need to be "healthy."  It took me a long time to understand that I wasn't someone who loved to exercise, I was someone who was addicted to exercise.  And that "healthy eating" was a big joke--I didn't give a damn about health and I knew it.  But it was something that would make other people get off my back, and for a long time, I honestly thought there was nothing wrong and I had the situation under control.

The rigidity of anorexia fit my persona: the driven go-getter, the ambitious student.  No one questioned that things might be going to far until they were so far gone that I was well and truly f*cked.  My attitude towards life was reflected in my attitude towards food.  Nothing less than the best. Don't play if there's still work to be done. You're too lazy, you need to work harder, you're going to fail.

And that has been the hardest part of letting go, having to give up the one thing that seemed to make life easier.  What has helped was realizing that it didn't actually make life easier, it just made life seem easier.

*I still get skeevy when people say an eating disorder is "all about control."  It's not all about control, but control is a major theme for many people with eating disorders.

Last night, I had a fat attack.  My old therapist back in Michigan would have preferred that I reframe it as a "bad body image attack."  Well, maybe.  But this feeling was very different than looking in the mirror and saying "Ewwww..."  Which I've also been known to do, but not last night.

For starters, I was laying in bed and not looking in the mirror.

For seconds, it wasn't a visual issue.  It was a more physical, visceral issue. 

I wanted to claw my way out of my own skin.  I felt huge, uncomfortable.  I couldn't stop thinking about my body.  I wanted to do something, anything to get rid of this feeling.

Somewhere through the anxiety, I started thinking, "You know what this reminds me of?"

OCD.

I had the stereotypical germ OCD when I was in high school.  Mostly, I obsessed and worried over every little thing.  Either I was harboring some nasty germ that was going to kill everyone I knew or saw or had contact with, or everyone I knew, saw, or had contact with had a germ that was going to kill me.  I would wash my hands or reply scenes in my mind to make sure I hadn't touched something "bad" or coughed wrong or whatever.  I would inspect every inch of my skin to make sure I didn't have any cuts that could get or receive germs.

Therapists call these contamination fears.

I felt like my skin was crawling with germs.  I washed my cracked, pathetic hands in bleach to try and make this feeling go away.  No, I couldn't see the germs. I wasn't always 100% positive they were there, but I was sure that I could feel them.  All I wanted to do was make that feeling go away.  If it meant screaming in pain from bleach, so be it.  I was so distressed and terrified that nothing else mattered but making this feeling go away.

Which brings me back to the fat attack.

I didn't feel that my skin was crawling with germs, but it did feel like it was crawling with fat cells.  And in moments like that, it suddenly doesn't seem so foreign/stupid/pointless to do something like purge or overexercise.  I didn't, but nonetheless.  Thinking of these fat attacks as another manifestation of my OCD has made a lot of sense to me.  Yes, I have significant body dysmorphia above and beyond the fat attacks. 

Yet any time off exercise or eating something "unsafe" or "forbidden" would bring about a fat attack--just as touching something dirty would set off a contamination attack.

I don't think this totally explains my eating disorder.  Not at all.  But it does explain parts of it.  It helps explain why I would do such crazy things.  To escape the distress.  To keep the calm.  Vanity and sticking to my "diet" wouldn't--couldn't--explain this.  If you're scared enough, you will do some crazy things.

I never was able to recover on my own as an outpatient because the fears and the feelings were just too strong.  It meant living in a non-stop fat attack for months with no sense of relief.  Considering the crazy stunts I pulled to avoid the feeling just for a few hours or days, is it really any wonder that I tried to avoid refeeding and recovery?

Seeing fat attacks as OCD helps me calm down in the moment.  It's just the OCD talking.  The OCD was wrong about me spreading or receiving the plague, so it's certainly wrong about this.  What's more, I know the awful feelings do pass.  Eventually.

Like many people, I have been following the story of the Chilean miners and the rescue. As a writer/storyteller, the saga has been enthralling.

But my friend Charlotte had this to say:

"I spent all day yesterday weeping, watching the Chilean miners coming up. All I could think of was that this was what it must have been like for my d, in the depths of ed, a dark and frightening place. H, other d and I strapped her into her tiny capsule and have heaved and heaved and she is now above ground, learning to take off her sunglasses.

IMHO, you need to strap your d in her capsule and start pulling. Think of bringing her out of the darkness and back into the light. It is a terrifying and claustrophobic journey, but well worth it in the end."

Except with an eating disorder, you're not entirely sure you want to come to the surface. You start to find the darkness comforting, and you find you forget what it's like to be on the surface. The darkness is simple, predictable. You know exactly what to expect. And the longer you are down in the hole, the more frightening it becomes to even think about coming to the surface.

I would climb into the rescue capsule on occasion, but as soon as I started leaving the darkness of my eating disorder, I panicked and climbed back down.

Even though I've been on the surface for some time, I often think about the safety of the darkness. That as much as I'm enjoying being back in the land of the living, I still think about my time down below. I'm not debating going back to the eating disorder--that's not it. It's that the ambivalence about recovery can persist. You ask yourself: Did I do the right thing by coming to the surface? Wouldn't it be easier to stay in a cold, dark hole?

The answer to that last question is definitely yes. But life isn't about easy. Easy is boring. It can be lonely. I'm still adjusting to the sunlight, but I am, in fact, adjusting.

I've written on my life as a "high functioning anorexic" before--indeed, for much of my eating disorder, I was almost certainly functional. I finished college and completed two master's degrees. Outside of a seven-month treatment stay and several brief hospitalizations, much of the past 8 years was spent living as an otherwise "normal" person.

See? My eating disorder really isn't that big of a deal!

The problem wasn't just that I peddled such drivel to friends, family, and therapists (I'm fine! I'm not that sick!), I also began to believe my own bullshit. If I wasn't that sick, then why would I need to worry about getting better? I had a full-time job, I was in school, I was just fine, DAMMIT.

The problem is that "high functioning" is a bit of a myth. How well you are functioning isn't always a measure of illness severity; sometimes it's a measure of how well you can hide just how awful things are. My heart was whacked, my digestion non-existent, my body shutting down, and yet I was maintaining a straight-A average in college. Several professors didn't understand how I could be leaving school "when I was doing so well!"

Many times, when exactly how bad the eating disorder, anxiety, and depression really were came out into the open, it usually wasn't because they were suddenly worse. Rather, things started to appear really bad because I began to lose my ability to compensate for my illness. I carefully constructed my life around my eating disorder so that I could protest with all wide-eyed innocence that everything was fine. Sure, I had no life outside of my job and the gym and the online calorie counting guides, but I got to work everyday. No one knew my dirty little secret that I had once been locked in the loony bin, that I had come perilously close to starving myself to death.

Blogger Meggy Wang writes:

Bipolar disorder* is considered a “severe mental illness,” however, and in order to protect myself from feeling like a nutcase, I still call myself high-functioning. As in, yeah, I started having hallucinations when I was a senior in college, but I also graduated with a 3.99 from Stanford.

But lately I wonder whether my own insistence on calling myself high-functioning is both a defense against self-stigma and a defense against perceived external stigma... To define myself as high-functioning, then, is my way of separating myself from what I do not want to be. By doing so, though, I suspect that I’m playing my own major role in stigmatizing mental illness, as people with mental illness get a bad enough rap without divisive factions within. I'm thinking about people of color stratifying via skin tone from dark to light. It's hard enough to be a member of a stigmatized group without having other members claiming to be "better," more "normal," more like the majority. Even if the majority is what I often wish I could be.

Obviously, our mental illness significantly affects our ability to function--if it didn't, we wouldn't have a mental illness. Certainly there are degrees to which a mental illness will affect our lives, and often an increase in illness severity corresponds to a decrease in functioning. Yet being high functioning doesn't indicate a lack of illness severity, either. It just means that you, like me, could compensate really well for the internal havoc of your mental disorder.

Those times when my life crumbled down around me, when I could no longer compensate for the madness and obsessions and compulsions, those were the times when I felt relief. Finally, I thought, I will get the help I need. I can stop hiding just how bad everything really is. Of course, the severity of the situation simultaneously humiliated me, which is why I didn't say anything in the first place.

In the end, we can be united by our common diagnoses and neuroses, or we can use that to split ourselves into a group of the "sick" and "not-sick." This isn't to say that we are our diagnoses, but that whether you're an anorexic sitting on a park bench or Park Avenue, you share the same struggles as me and so many others like me.

My brain is rather noisy- there's a cacophony of chatter always going on between that crack team of me, myself, and I. And here's the thing: this chatter never shuts up. Never. If I'm not fretting about something, then I'm trying to anticipate what I might need to do later, the order in which I need to run errands in order to use the least amount of gas, or just daydreaming about something or other. There is never any silence.

Starving myself didn't necessarily stop the chatter, although it did turn the volume down, especially on the self-loathing thoughts. Because as long as I was restricting and over-exercising, at least I could do something right. One of the many reasons that I found it so difficult to start eating on my own again was the fact that eating cranked the volume up on my ED-phones, and I really missed the (relative) peace that came when I was following my strictly limited diet.

At the 2010 Salzburg International Conference on Eating Disorders, Laura Hill from the Center for Balanced Living spoke at length about how recovery from an eating disorder makes the brain "noisier." This noise--this constant cacophony--drowns out almost every shred of sanity that remains.

Said Hill:

Silence doesn't come to anorexia patients if they're eating. When a person without AN eats, brain is relatively quiet. When a person with AN eats, they experience high anxiety, thought disturbance, and "noise." The noisy AN brain [has] layers of noise. The longer [they] delay eating, the lower the noise gets. Recovery doesn't mean that the noise goes away, it means you understand it and manage it better.

To some extent, you get used to the noise.

Ironicially, Hill said that the noise is at its worst just as you reach a healthy weight--something I can attest to rather well. I asked her what happened to the noise level as you maintain a healthy weight in spite of your brain shrieking that "YOU ARE A FAT F*CKING PIG!!!" I wanted to know (for my own selfish sanity!) whether the noise dropped.

Yes, she said. It did.

This one thing--the gap between when your body reaches a healthy weight and your brain begins to follow--is the most difficult, annoying, and frustrating thing in recovery. For all intents and purposes, you look well. You're eating. You don't cry in restaurants and dressing rooms (at least not every single time). But your brain is still deeply anorexic. This is when despair can take over. The noise is worse than ever and yet everyone thinks you're "fine."

At least when I was visibly sick, I thought, people knew I was suffering.

The noise goes down. This is what I've been telling myself. The noise goes down and I will adjust to eating and being at a higher weight than I've ever been and life will go on.

(Laura Hill's talk was so good, I have another segment for a blog post tomorrow!)

My language isn't exactly pristine, but I'm not a potty mouth, either. I can let the curse words fly, but I generally don't. Still, I use the s-word a little too much for my own good.

No, not that s-word. The other s-word: sorry.

Sorry is a good and useful word that should probably be used more often in some situations (public transit) and less often in others (pre-teen sarcasm). I would like to think I apologize when I am genuinely sorry, but that's not really the point of this blog (sorry about that!). The point is when I apologize for things that really weren't my fault.

I've become immune to how much I say "Sorry 'bout that" throughout the day, and it was only when a co-worker brought it to my attention that it hit home. (This was the co-worker who asked why I was upset at being hungry, not the one who told me to let my titties hang out.) The direct quote was something along the lines of "What the hell are you apologizing for? You just knock that off!"

My response? "Sorry!"

Yep- I'm pretty hopeless in that respect.

I'm not a stereotypical people pleaser--I'm pretty selective in who I bend over backwards for--but I am terrified of someone getting mad at me. Part of how I cope with that fear is by apologizing profusely and otherwise keeping my mouth shut. I don't ask myself whether someone is actually upset with me, whether that anger really matters in the long run, or whether I have any reason to be sorry for my actions. I generally just apologize. Sorry for being in the way. Sorry for not being there. Sorry for existing at all.

When I was deep into my eating disorder, I truly was sorry I existed. I was sorry I took up space and resources, and sorry I was me. This mindset pervaded everything I did. In my first hospital stay for anorexia, I was standing in line in the hospital cafeteria (I was actually pilfering Equal packets for later) and another boy pushed in front of me. What did I say? "Sorry." It was reflexive. I was clearly in his way. This somehow got brought up in group therapy, and so I was told to not apologize for anything for 24 hours. It was hilarious- I didn't even last 24 minutes until I was apologizing again, and then apologizing for failing to follow the instructions not to apologize.

I've gotten a little better since then, but not much. I still have that mindset that I am in the way, or that I am a bother. Really, that my existence means I have something to be sorry for. I use oxygen/water/food that would be better for orphaned children/serial killers/feral cats. Self-esteem problems? Where would you get that idea?

Working in retail, the ability to apologize for anything does come in handy. I've been told to apologize for whatever it is, and then make the situation right. This is strategic and differs dramatically from the reflexive oh-I-suck type of thinking that I otherwise engage in. I've apologized to diffuse a very tense situation. Like I said, saying "sorry" can be useful. It's just that I really don't use it in those useful ways very much.

I know I need to start working on valuing myself more as a way to stop apologizing, and I also need to just break this habit. It's just a matter of how.

This study just irritated me: Psychiatric 'diseases' versus behavioral disorders and degree of genetic influence

The study's premise was that

"Psychiatric conditions in which symptoms arise involuntarily ('diseases') might be assumed to be more heritable than those in which choices are essential (behavioral disorders). We sought to determine whether psychiatric 'diseases' (Alzheimer's disease, schizophrenia, and mood and anxiety disorders) are more heritable than behavioral disorders (substance use disorders and anorexia nervosa)."

...And what do they think drives behaviors? Have these researchers even thought about what anorexia actually is? No, it's not a bunch of skinny dieting champs. It's about being scared to eat. Which strikes me as less of a behavior and more of something arising "involuntarily."

I've heard some people say that they chose to be anorexic, but I would say that for the vast majority of people, they didn't choose their eating disorder. I know I didn't. Did I make the choice to lose a few pounds and exercise more? Yes, I'm not denying it. But choosing to head to the gym regularly is totally different than choosing to be anorexic. The first I will concede; the second I most definitely will not.

It frustrates me. It really does, especially because this is a scientific study carried out by actual professionals. I can grit my teeth and try and explain to Jim Bob that I wasn't randomly deciding to live on Diet Coke and look like a model because he very well might not know better. But psychiatric specialists? Seriously?

Interestingly, they didn't consider OCD in their spectrum of diseases, which would be interesting since it involves what they would term "involuntary" symptoms (obsessions) as well as chosen behaviors (compulsions). Nor did they address how people with depression are often told to cheer up and snap out of it, which implies that it really is a choice.

There are endless choices I've had to make as I've recovered from my eating disorder, although many of them were a choice amongst lack of alternatives. I've been told recovery is a choice, and although I don't think that's wrong, I don't think it's that simple. It's not as if recovery is one single choice, and it's not as if our brains always have the same capacity to make these choices as we move through recovery. There is some small amount of choice when my brain is compelling me to engage in ED behaviors or OCD behaviors, and I can see that now that I'm no longer in it on a minute to minute basis. But in the moment? I didn't see a choice, and my brain chemistry tipped the scales so heavily in favor of the disordered behaviors that I couldn't un-choose my disorder without a serious amount of support.

Ultimately, the study didn't find that "behavioral disorders" were any less heritable that psychiatric "diseases." They found a 60% heritability rate for anorexia, although other studies have found rates of 70% and Walt Kaye frequently uses an interval of 60-84% heritability (I believe this can be found in his Maudsley Parents lecture here).

The authors concluded:

No systematic relationship exists between the disease-like character of a psychiatric disorder and its heritability; many behavioral disorders seem to be more heritable than conditions commonly construed as diseases. These results suggest an error in 'common-sense' assumptions about the etiology of psychiatric disorders. That is, among psychiatric disorders, there is no close relationship between the strength of genetic influences and the etiologic importance of volitional processes.

Maybe that's because these "behavioral disorders" really are diseases...

Well, kind of. The blog Noshtopia posted an interesting question the other day: Does Your Relationship With Food Reflect Your Relationship With Yourself? As I read through Stephanie's blog post, I realized that my eating disorder was focused on the food, yes, but it reverberated throughout my life.

Right now, at where I am in my recovery, I would say that I'm anxious and cautious around food. I hesitate. I hold back. I worry the food might somehow "hurt" me. I don't trust food or myself around it. I still want to not need food--although I am able to follow through on my meal plan even when unsupervised. At the bakery, people have started to learn that I typically turn down samples. The little nibbles that others take for granted, well, I don't. I'm still afraid, still nervous, still have that freaky, hyper need for control. Food overwhelms me. And the more I think about it, the more I realize that this really does reflect how I feel about myself and my life. I am very hesitant and anxious about many things, not just food. In conversations and interactions with others, I hold back. I worry how something might hurt me. I don't trust others very easily, and I definitely don't trust myself (hence the uber-rigid following of the meal plan). I feel, ultimately, rather needy.

At the height of my eating disorder, I hated food, I hated life, and I hated myself. I was terrified of everything. I withdrew from everyone and just totally shut down. I stopped eating. I stopped living.

It's hard to really separate the two, those two things we refer to as eating and living. Obviously, life involves quite a bit more than eating. But how we eat says a lot about how we live: what we value, how we like to spend our time. Your food doesn't define you- a steady diet of Taco Bell doesn't make you a bad person. Enjoying and relishing this steady diet of Taco Bell is different that being afraid to eat at any place besides Taco Bell.

When I think of myself in more meta terms, I use adjectives like quirky, curious, funny, shy. Before the eating disorder arrived, you could see these (in some sense) in how I approached food. In high school, a friend suggested we try a Thai restaurant for lunch. Thai was pretty exotic for my small-ish suburban town, but I was curious and agreed. I kept my order very tame, but I enjoyed trying new cuisine. And really, that was me. I need a lot of encouragement to try new things and to put myself out there, but I'm also rather curious. Many times, some of my best ideas have stemmed from the thought, "I wonder what would happen if..." Okay, some of my worst ideas have also stemmed from that thought, but still. I dragged my parents to a Vietnamese place in my new town after reading a restaurant review. Without the review, I probably never would have gone. But we went and had fun. I didn't try anything exotic, but I liked my selection and what more could you ask for.

So these "meta" terms for myself are also now ways in which I want to approach fixing my style of eating. For me, balancing my natural curiosity with my similarly natural tendency to prefer the familiar is probably going to take the most work. I easily fall into eating ruts, just as my life easily falls into ruts and habits. I like tooling around in the kitchen and throwing stuff in a pan and seeing what happens. I prefer to work with a recipe, but I can improvise as needed.

As goes the food, as goes my life.

How does your relationship with food reflect your relationship with yourself and your life?

I stumbled across this story in the UK's Daily Mail ("Emily's mother told her she wasn't welcome at home while she was anorexic") and it really got me thinking. The gist of the article was that Emily's mother said that her anorexia was no longer welcome in her mother's new home. Emily's mother said she had exhausted other options and didn't know what else to do. Most of the commentary I've read about the article usually involves shrill accusations that her mother is a creep, no wonder Emily had anorexia, and so on. That's not really what I'm interested in. What really resonated with me was Emily's response to her mother's ultimatum:

But with her mother's words ringing in her ears and her friends frantic with worry over her emaciated body, in July 2008 she decided to attend an eating disorders clinic as an out-patient.

'I couldn't bear how life was any more,' says Emily. 'I felt there were no other options left.'

And it was that last line, "I felt there were no other options left," that hit home. For me to take the first tentative steps towards recovery, I needed to know that there were no other options for me. I knew that no one on my treatment team or any of my family and friends would support my eating disorder. Just as importantly (or perhaps more so at the time) was that I had exhausted all of my other options. I had done the route of hospital/residential/partial and round and round for years. I had tried ignoring the eating disorder. I had tried various forms of outpatient therapy, support groups, group therapy, online support, you name it. I had tried embracing the eating disorder and trying to make the best of it. In the end, the realization that slammed me and allowed me to start tentatively giving up the eating disorder was realizing that I couldn't have both the life I wanted and the anorexia. I knew anorexia, and the anorexia sucked. That wasn't what I wanted for me.

Last June, my options were limited: keep going with the anorexia and die, or go home and try to get better.

My old therapist is fond of the phrase "choice amongst lack of alternatives." In the early days of refeeding, it meant I got to choose between orange or apple juice at breakfast. If I didn't or couldn't pick, then my mom would pick for me. But there was no getting out of the juice. So I started to make some choices. My recovery was, in a sense, the same way: a choice amongst lack of alternatives. What else was there for me? I had exhausted all my other options and there was nothing left for me to do but get better.

This wasn't a lightbulb moment or an epiphany. In fact, I didn't even realize it for quite some time. Mostly, I felt discouraged and demoralized that I had failed at both life and anorexia. Yet it was the lack of other options that enabled me to start standing up to the eating disorder and begin the process of eating and gaining weight. The idea was so overwhelming and frightening that it literally needed to be the only option for me.

The irony is that this very lack of choice ultimately opened up so many choices for me. I now get to decide what I want to write about, I can pick out what I want to eat, I can conceive of a life that doesn't involve juggling an eating disorder along with everything else.

The word "no" is so fundamental to my eating disorder. No thanks, I've already eaten. No, I think I'll pass. No, I'm busy tonight. It was a lot about avoidance. If whatever it was might interfere with my eating disorder, I said no and backed away. And the eating disorder itself was a house of cards built on the concept of no: no food, no rest, no flesh, nothing.

As I work more in the bakery, I am being asked about how certain things taste or which items I prefer. Sometimes I'm honest and say "I haven't tried that," but sometimes I spin fairy tale stories about how good a particular item is. Part of it is my Inner Writer coming out, and after 10 years of anorexia, I have gotten pretty good at imagining what things must taste like (okay, the little descriptions on the back of the signs don't hurt, either). The irony is this: I can imagine what many of these things must taste like, but I have much greater difficulty imagining myself eating them. It's not the decadent items themselves that cause anxiety, it's the idea of saying yes to them.

So why does saying "yes" cause me anxiety? If I distill the question down long enough, I get this answer: shame. Shame of eating these things, shame of spending so much money on them, shame (and this is the kicker) of wanting them. It is hard for me to want things- it triggers all sorts of feelings that I'm greedy and selfish. I've more or less accepted that I need to eat, but it's hard for me to accept wanting to eat.

I am, by nature, a rather avoidant person. Much of the avoidance is rooted in fear. This fear, combined with a pervasive sense of shame, led to my decade of "no." It's a habit at this point, though not a good one, and I know that this mindset (the "No, don't" mindset) needs some work. Working in the bakery, there are often samples around, samples that we can try- as long as the customers don't see us. I've steered clear of those, with only one or two exceptions. My co-workers will help themselves and see nothing wrong with it. I have a hard time imagining myself actually just shrugging my shoulders and taking a bite.

I challenged this a bit the other day when I had the equivalent of a small slice of cake as part of my evening snack. I challenged it a bit more today when I bought a four pack of red velvet cupcakes for my parents and me to try. Whether I'll ever start my own personal "quality control" efforts for all the items in the bakery (as one of my co-workers puts it) remains to be seen. I doubt it. But I'm trying to start saying yes just a little bit more often. Yes to food, yes to something new, yes to life.

The past few days have been a little on the overwhelming side. Nothing to do with the eating disorder as much as it has to do with everything else.

It started with the realization that the COBRA health insurance I was buying from my old employer was $100 more each month than I thought, bringing the total up to almost $700/month. I had got a notice in the mail saying my account wasn't paid up, so I called the 800-number and talked to a girl who sounded all of 18, max. When she told me the reason why (I had been billed for the wrong health plan) and then told me the monthly rate, I asked her, point blank, "Are you shitting me?!?"

No. No, she wasn't.

I had been looking for a part-time job in the hopes that I could find one that offered health insurance. I really couldn't. Now with the cost of COBRA, I knew I had to find a full-time position. I had interviewed for a part time position at a local gourmet grocery store, and I called back to see if they had any updates. In my conversation, I realized that the store considered full time anything over 30 hours/week, and that came with health insurance. It was pretty much just the solution to my problem.

Anyone care to guess the department in which I was hired for said full-time position?

That's right: the bakery.

I'm not doing any real baking, more of a customer service type of job that happens to be in the bakery. When I thought about working around food, I felt no real anxiety or apprehension (it felt the same as if I were going to be selling sunglasses), nor did I feel a thrill of excitement like an alcoholic working in a bar. If things go to shit, I'll re-evaluate. Until then, I have a pretty okay feeling.

So just call me Captain Cupcake.

I also started work on my first official freelance writing assignment for a geology magazine, and played whack-a-mole for several days working on that, plus some even greater angst from another writing project that is driving me nuts. So with all of this happening, my anxiety has been off the charts. My foot might very well tap itself off my leg. I feel better today- still unusually anxious (even for me!) but at least I'm not wanting to claw out my own eyeballs.

I have to do my work orientation in a few, so I need to grab some lunch before I head out.

What do you do when you feel overwhelmed (that's not ED or otherwise harmful)?

I'm aware my eating disorder is a problem in my life. I'm not paying The New Therapist (TNT) big bucks because my life is fine and dandy and turning out just the way I hoped it would. I'm also aware that things didn't really start to go to pot until the ED kicked in, full-force. This would naturally lead to the logical conclusion that the eating disorder is a problem. And I suppose, when you look at it in more of a vague, almost existential sort of way, I get that the eating disorder is a problem.

But when I have thoughts about restricting, about hiding food, about exercising, about losing weight...I don't see these thoughts as a problem. It's the things that are preventing me from restricting, hiding food, exercising more, and losing weight that are the problem.

My OCD-type thoughts are distressing, and I view them with a mental "Ew, ick, get that out of my head!." The compulsions aren't welcome, but the (temporary) relief they bring from the obsessing is, and so the cycle begins. If you had a magic wand and approached the teen Carrie and asked her if she wanted the OCD stuff gone from her life, she would have said yes, please, take this away from me.

The anorexia is a little different. I do want the eating disorder gone from my life--it's ruined me in every way I can think of--and I'm no longer in denial about the fact that I do have an eating disorder. But when I have ED-related thoughts and urges to engage in behaviors and even (oh lordie...) actually engage in behaviors, I'm not wishing for some sort of magical fairy godmother to make these thoughts and urges go away. Because these thoughts and urges and behavior seem so logical at the time. Feeling like a fat, lazy slug? Duh- exercise more! Feel that you have to eat too much? Slip those eggs into your pocket.

When I was still working full-time in Corporate America last year and in the throes of my exercise addiction, my presence was requested at a lunchtime meeting. This was problematic because I exercised at lunchtime, and if I was at a Big Meeting in front of Important People and theoretically Representing My Agency, I couldn't very well sit there and not eat. I had several days' warning, which gave me plenty of time to stew about appropriate options. As the day grew closer, I debated whether or not I should fake food poisoning to get out of this dumb meeting. Now, even without any eating disorder I wouldn't have wanted to go to this meeting and probably would have come up with half a dozen bizarre excuses not to go that I never would have had any intention of using. My thoughts about the meeting would have been more like "grumblegrumble...stupid lunchtime meeting...grumblegrumble." I wouldn't have contemplated calling in sick to avoid it. But in my mind, the problem wasn't that I was so addicted to exercise that I couldn't contemplate even taking a small break or changing my routine. The problem was (you guessed it) that stupid lunchtime meeting.

In the end, I went to the meeting, divided up my usual lunchtime exercise and tacked it onto the next two days' evening routines.

I'm often unsure about whether I see the ED as sort of a foreign invader or as just a really f*cked up part of my own brain. In a sense, I suppose that's not as relevant as seeing that voice as something I should fight, something I should want out of my life. I struggle every day to see the ED as the problem, and I haven't been able to do it. I suppose this is what the psychologists mean when they define an illness as "egosyntonic." I want it anorexia to disturb me, to fill me with a shuddering dread whenever I think about ever deliberately skipping another meal or tethering myself to a StairMaster. I suppose that's a start, because for so many years, I actively welcomed the anorexia. Even now, though, I find the idea of "having" to eat a meal when I don't want to or not being able to exercise when I want/need to as being the actual problem, not response. I don't know how to get to the point where I actively start fighting the ED off, because when push comes to shove, the thoughts and behaviors don't seem all that problematic.

How did you integrate the idea of "ED as a problem" into your own recovery?

I had my third session with The New Therapist (TNT) yesterday, and we discussed some of the chapters that she asked me to read from the book Full Catastrophe Living by Jon Kabat-Zinn.* And one of the segments talked about a woman, Mary, who felt like this huge truck was always on her heels. When asked what the truck represented, she responded that it was her impulses and cravings, her thoughts and feelings. In other words, that truck was her mind.

Substitute "obsessions and anxieties" for "impulses and cravings," and you pretty much describe me. I have this mental feeling of something always being on my heels, that I'm being chased or followed (not literally, of course). I always feel like I have to keep pushing my brain to stay one step ahead, to anticipate what might go wrong or what might happen next. It's that perpetual stream of "what if" questions that always seem to plague me. It's the fact that my brain never seems to shut off--it's always whizzing away with some thought or idea or worry. These leave me feeling mentally exhausted and frustrated because that truck--my thoughts--were always pushing me and following me.

So I expanded with TNT on this metaphor. I think my exercise habits were part of a way to try and "outrun" this truck. If my normal everyday life was the equivalent of "walking," and it left this truck always on my heels, then maybe if I walked a little faster, the truck would leave me alone. Or I could at least get a bit of peace and quiet. And to some extent, it worked. Part of the purpose of exercise was to exhaust me to the point where I was too tired to worry- or at least too tired to care. The "truck" was off my heels for at least a little bit.

Except the truck always came back, and I started adding more exercise so I could try and find more peace of mind. And yeah- we all know where that brilliant idea led.

Now I'm back to living life with this truck dogging every step I take, every thought I have. Part of what TNT explained is that one of my tasks in recovery is to accept and make peace with the truck. To stop being so intimidated and frightened of it. The goal is less to make the truck go away, or try to convince myself it's not there--no amount of therapy is going to make me into a not-anxious person. The idea is to make the truck less distressing and annoying, to stop fighting the fact that it's following me. To make the truck into more of a butterfly or at least more like my shadow. It's there. I know it's there. I notice it, but it doesn't bother me. That's the difference.

What's your truck? How have you learned to live with it?

*She describes her approach as CBT seasoned with mindfulness techniques. Works for me.

Many people with eating disorders report a "voice" in their head that tells them to starve, to binge, to purge, to exercise. This voice hisses and spits while they look in the mirror and try on clothes. It congratulates you on every pound (half-pound, quarter-pound) lost. Jenni Schaefer calls her eating disordered voice "Ed," and considers it separate from herself. Ed is the voice of an eating disorder, and not the voice of Jenni.

I think this can be a tremendous therapy tool, and have tried it myself, except for one tiny detail: my eating disordered voice sounds exactly like me. I can be sitting in the car and driving, trying to figure out how many miles I have left before my destination, whether I should pull through the car wash, whether I might need the oil changed, and slide seamlessly into a diatribe of self-loathing about how much I ate and how much more I should have exercised. It sounds like me and it talks like me and it can talk for me...so is it me?

What makes it even harder for me is the fact that I've been hearing this voice, in one form or another, since long before I ever had an eating disorder. It was the voice that told me I was a loser because I couldn't write the cute bubble letters like the other girls my age and that no one would like me. It was the voice that scolded me for not getting a perfect score on my spelling test. It was the voice that said no one would ever want to be my friend, so I may as well get over it. It was the voice that told me my high school graduation honors were a matter of luck.

If I could condense down everything the voice told me into one simple phrase, it would be: No, don't. Should I go to the party? No, don't. Should I eat that cookie? No, don't. Should I speak up? No, don't. Should I break out of my routine? No, don't. Should I buy those jeans/that book/that expensive bar of chocolate? No, don't. It's a life of "No, thank you, I shouldn't, I couldn't, I would never." There are situations when this is a sensible path to take--it tends to protect personal safety, and that's not a bad thing. But when that's your life, when that's all you know and all you will let yourself know, it's not quite so universally positive.

I was at a get-together last night with a friend of mine. I was visiting L for the weekend (I'm sitting on her floor as I write this), and she was invited to a small party with some friends of hers, and I tagged along. I had previously met almost all of the people there, and they were all really nice people. I knew that weren't judgmental or anything--that wasn't what I was worried about. I hesitated to join in on the conversation because I was afraid I would say something stupid, afraid I would offend someone. Should I join in on the talk? No, don't. It was when someone broke out the karaoke machine that I really started to shut down. I didn't know many of the songs, and even when I did find a song I remembered, I knew I would never ask to sing it. I was too afraid of embarrassing myself. The other girls who were singing seemed to have quite a bit of talent, and I was certain I would sound rather terrible next to them. I can't belt out lyrics- my voice just doesn't seem to go that loud. The clincher was the fact that the computer system gave you a score at the end of your song. I was certain that I wouldn't get the highest score, and I knew that if I didn't, I would hate myself. So I didn't sing.

There was a part of me that just didn't feel like standing up and singing, which is fine, but I've never really been able to cut loose, be goofy, and just have fun. I'm always thinking ahead and anticipating what might be next, how I could look like an ass. Although these thoughts have nothing to do with food and weight, they still seem like a product of the anorexic voice, of the perennial chatter I hear in my head that seems to come from within.

Perhaps one of the hardest parts is this: it's not always mean. Sometimes, the voice is kind and reassuring, like "Yes, I know. It's okay. I'll do better tomorrow." The unsaid piece is that there will be hell to pay if I don't shape up, but still, I'm not berating myself, I'm encouraging myself to do better, to eat less, to exercise more, to study harder. Most of my major relapses started out this way: I started to cut back on food, and if I slipped up, I gave myself a pat on the back and said that tomorrow would be a better day. As the relapse progressed, the voice became harsher and more demanding.

It turns out I'm not the only person with anorexia who has seen this progression. A recent study in Psychology and Psychotherapy asked anorexia sufferers to describe their experiences living with the "anorexic voice" and found that:

These data underlined the positive and negative attributes individuals bestowed upon their anorexic voice; the former appeared stronger during the early stages of their eating disorder, the latter coming into force as it developed. In spite of their voice's harsh and forceful character, participants felt an affiliation towards it. The bond between individuals and their anorexic voice could explain their ambivalence to change. Therapists must persist in their endeavours to penetrate this tie, whilst acknowledging the hold this entity has over those with anorexia. Interventions that address this component of the eating disorder could prove fruitful in helping people towards recovery.

I'm not sure I have a quote-unquote "bond" with the voice in my head, but I do know I'm used to it, and its presence doesn't really bother me. Furthermore, I find it hard to say for sure whether this voice is external or internal. Since it seemed familiar even at the outset of the eating disorder, it feels like it's always been there, even if I wasn't harping at my food intake and weight. It seems ultimately like a perfectionistic voice that happened to become utterly myopic about food and weight.

Do you have an ED voice? How do you experience it? In your comments, I want everyone to feel they can be open and honest; however, I'm also aware that such discussions can be triggering, so keep that in mind as you share. Thanks!