If We’re Not Working on Recovery, We’re Working on a Relapse
Can you be surprised by the fact that you have an eating disorder? Can you be surprised by the fact that despite having had two eating-disorder unit admissions, you have relapsed? Yes. Yes you can. And it’s shit.
Still in hospital, I went into my Team Meeting about 2 weeks ago and was assaulted with the unexpected- an intervention. A multi-disciplinary team meeting, there were only about forty people present (slight exaggeration- consultant, registrar, pharmacist, psychologist, social worker, community nurse, ward nurse and sometimes a med student or two), so when I say intervention, that is what it felt like; and assaulted wasn’t an exaggeration of how it felt. I was told that my weight had become a serious issue. I laughed at them, I told them to check the nurses’ records, I attend all my meals. I’m not trying to lose weight. I’m not purposely restricting my diet. If my weight was an issue I would know about it. My doctor told me that if I dropped below X-kg’s I would be put on bed rest, and I was only .1kg away from that. I cried, I argued, I tried to defend my weight loss as being circumstantial and as it wasn’t affecting me, a non-issue. However, the team remained determined to talk only of my weight and nothing else for the meeting, so I left feeling ambushed, overwhelmed, and ganged-up on, outnumbered, bullied and like an injustice had been done to me.
My boyfriend, Luke, came to visit me in the afternoon and I vented all of this to him, swearing like a sailor, cursing the progeny of all those who had humiliated me and crying like a child that’s just thrown all their toys out of the pram. The man has the patience of a saint. He sat and listened to me, cuddled me, told me he loved me- and then he turned to me and said; “But you know you’re anorexic, right? Someone that doesn’t have an eating disorder would not have the same reaction you just did. You’ve relapsed. But you’re going to get strong again.”
I thought that because I was eating regularly and not deliberately dropping weight that it was purely circumstantial that my weight was dropping, therefore not my fault or proof of a relapse into an eating disorder. However, my weight had dropped below the point where my brain is properly functioning. I had, without even realising it, been refusing desert, steering away from calorie-dense foods, turning down offers of sweets or chocolate on the ward, even around Christmas time and thinking a lot about what I ate; what was in it, was it processed, who had touched it, etc, etc. In my mind, I just didn’t desire those foods; I was eating healthily and was happy about that. Only in hindsight did I realise that anorexia had crept up in my blind-spot while I was weak and distracted by the other mental issues I’m battling.
A starved brain leads to cognitive deficits which make it difficult for patient with malnutrition to engage in psychotherapy or talk of them having an eating disorder. They are set in their ways and a change to their routine is extremely anxiety provoking. It is for this reason that nutritional rehabilitation and weight restoration are key components of the recovery process, before the real healing of self-acceptance, self-love, talk-therapy and full body and mind healing can occur.
And it is for this reason I could not see the wood for the trees when it came to my eating disorder. In previous sessions with my doctor I had been dismissive of his remarks on my weight, thinking he was overreacting and that I would never reach that X-kg number where he would actually put me on bed rest. Besides, hospital or no, I’m still teaching one class a week, how could someone with an eating disorder do that? And how could he possibly put me on bed rest, knowing how important that hour is to me?
Realising that the doctors were serious and I was only 100 grams away from bed rest and one of the only things that kept me feeling human- teaching- being taken away from me, it was like a fire was lit under my ass. I couldn’t believe I had been so blindsided. I couldn’t believe that ED had tricked me again, the bastard.
So, for the third time in my life, I began refeeding. I didn’t want to move to an eating disorder unit. I felt that I could do this on my own. I bought protein bars, soy yoghurts, nuts and seeds, I ate more at each meal and still avoided the desert- but this time by choice, and I substituted it with a yoghurt. In the evenings I drink a Fortisip (those who know, know, those of you who don’t are happier) and have a protein bar. I snack on fruit throughout the day. The food is monotonous and I eat practically the same thing every day, but I’m not enjoying food anyway. Food is medicine right now. Food = calories. Calories = energy. Energy from food = my body resisting the temptation to begin consuming its own muscle and organs. I’ve put on almost 1kg since this awakening. X number to go, but I’ll do it. I’ll prove to myself I can do it.
I’ve suffered the first fortnight of refeeding by myself, without the support of an ED unit. I’ve put myself in the dining room three times a day, I’ve not only eaten, but gone out and bought my own snacks, I’ve asked for my Fortisip every night because it doesn’t occur to the staff on a non-specific psychiatric unit to give it to me. When stock has run out, I’ve badgered them until more appeared, and on the nights when there were no Fortisips, I ate an extra protein bar instead. I’ve forced myself to eat when I’m full, when my belly is bloated, I’m constipated and full of trapped wind. I’ve forced myself to do the impossible; which, to some people, may sound dramatic, but; anyone who has ever suffered with an eating disorder knows, the force it takes to pull your own head out when it’s that deep in the sand. My body is literally only now re-learning what to do with proper amounts of food. My brain, my metabolism and my organs are all reassigning themselves to their original and proper workstations.
Given the low body weight, the body adapts to have a lower heart rate (bradycardia), lower body temperature (hypothermia), and lower blood pressure (hypotension) in an effort to conserve energy. During the early refeeding process, the body goes from a catabolic state (breaking down tissues for nutrients during malnutrition) to an anabolic state (rebuilding and repairing tissues). It switches from breaking down fat cells for nutrients to using carbohydrates as building blocks to repair and regenerate cells. This involves a whole switch-up of the body’s organ system and can be destressing, both emotionally and physically due to the foreign feelings of fullness and satiation, confusion of mixed emotions regarding food (pleasure versus guilt or disgust) and the physical symptoms that occur with the body’s return to proper digestive functioning.
I’ve put on almost a kilogram, lost some of it and put it back on again. My progress is definitely slower than it would be on an eating disorder unit but, I know I can do this myself and I want to do it. I want to be the Clodagh that can run and go to the gym and go for meals with friends without feeling some looming pressure. I want to have a glass of wine and dessert. I want to be the Clodagh that is smiling and full of energy and life and I know that the eating disorder doesn’t account for the absence of that entirely- I have a lot of other stuff going on right now. But, being a healthy weight will make every step after that a little bit easier. I can only fight one war at a time and right now I’m in a battle with my mental health. I don’t have time to go to war against my own body too.
As always, thank you to all you beautiful Yogilateral Warriors that make this blog feel worthwhile and make me feel like I have a voice and it’s being heard, somewhere out there.
You are my heroes.