goodbye july

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yet another month draws to a close. it seems inconceivable to me that it’s 1 august tomorrow and yet, when i think back to this time last year, i barely recognise myself. it was last summer that the ptsd really kicked in, fuelled by a combination of an incredibly stressful project at work and the final decision of the cps not to prosecute my rapist. the anxiety, nightmares, flashbacks and constant intrusive thoughts were killing me.

this year, i’m in a very different place and whilst the last few weeks have been rough for a variety of reasons, i do also feel like i’m beginning to make some tentative steps forward. some events which i feared would trigger a reawkening of the ptsd symptoms didn’t (or at least, they didn’t as much as i was expecting). and a lot of work with my psychiatrist has meant that i understand far more about myself and the root cause(s) of my long history of eating disorders than i ever have before. of course, that doesn’t mean that the issues are resolved overnight but knowledge is, as ever, power. i can start to recognise the behaviours (both in myself and in others) that i find particularly hard to deal with and, in time, i hope i’ll be able to implement strategies to handle these better.

there’s no time like the present to start though and i think august is going to be a particularly testing month. there’s a long list of social/family occasions over the next couple of weeks, all of which, obviously, involve food. and then we’re on holiday for two weeks with my parents and every aspect of my life (and in particular, what i eat and how i look) will be under scrutiny. not to mention that i’ll have to relinquish control over what and when i eat.

i don’t know how (or indeed if) i’m going to cope really. in the past i would have defaulted to my usual unhealthy coping mechanisms (last summer copious amounts of wine and self-harm featured prominently) but i don’t want that to be the case this year. and so i have the rest of today to come up with some better alternatives…

be that self which one truly is

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there has been a lot written on eating disorders and the role of self-identity both in terms of the part they play in the diseases themselves and in recovery (for example, here, here and here). anorexia (and other eating disorders but i will use anorexia for short hand) is so all-consuming that it doesn’t leave much time for anything else whether that’s family/friends/work or whatever else it is you do for fun. that, combined with the body dysmorphia that often accompanies anorexia, makes it hard to work out where the eating disorder stops and where you start. as i’ve got waded further into recovery, i’ve been made to challenge the core beliefs that i have about myself and my identity.

many of these core beliefs have their roots in my childhood. growing up, i was always the fat, lazy, academic child, more interested in reading a book than running around the garden. in contrast, my brother was skinny, excelled at sports and could never sit still. i was a fussy eater and mealtimes often became a battleground between my and my mother; often i’d sit there in tears being forced to eat something that i didn’t want to eat. my brother would eat pretty much anything. we had our roles in the family narrative and i’ve been trapped in mine ever since.

and so, when someone says how fit i am or how think i am or how healthy my diet is, i can’t believe them (and just typing out those things makes me feel uncomfortable and i’ve already deleted this paragraph several times because they are so far from the truth). even when i’m being told these things by a medical professional, the bullying voice in my head just shouts louder than them. the disordered behaviours which feed off that skewed sense of my identity also perpetuate the cycle, continually punishing that chubby 10 year old for not being good enough.

as a result, i often end up feeling disassociated from myself; like my sense of identity and the ground on which i’m standing is constantly shifting. there’s nothing tangible that i can cling to other than the restrictive behaviours which have structured my life for so long. all of which are a response to what i believe i (still) need to change about myself. actually, it’s probably more accurate to say that it’s not so much what i believe i need to change about myself but what i believe other people want me to change about myself. because my need for external validation is strong.

on the way home from an appointment with my psychiatrist yesterday, i realised that the main emotion i feel at the moment is fear. and one the things that i’m most frightened about is learning who i actually am when you strip away the anorexia.

{title quotation attributed to søren kierkegaard}

on ivf and eating disorders

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i write this on the ‘other side’ of our first cycle of ivf. everything went well – far better than i had any right to hope for – but it still ended up with a negative pregnancy test last weekend and, after a slightly delay while all the progesterone worked its way out of my system, the appearance of my period yesterday. the constant and gruelling nature of ivf hasn’t really left much time for anything else recently. we’ll try again in a few months (probably) but it’s bloody hard. it’s bloody hard for anyone. it’s really bloody hard when you’ve got an eating disorder.

i feel that i should start by saying that i don’t think my eating disorder is the cause of our infertility. everything is as good as it can be with me and i responded very well to the various drugs. when we started trying to conceive (a long time ago now), i was probably the healthiest and happiest i’d been for a long time. the eating disorder was definitely in remission and my relationship was food was fairly uncomplicated; it continued that way for a good 18 months (the fact that it got more complicated again is nothing really to do with the infertility). lots of people who have/have had eating disorders conceive naturally. some people who have/have had eating disorders need some help. it’s the luck of the draw really. (i should also add that i’ve also only ever had relatively short periods of amenorrhea in the past too).

for someone with such a litany of mental health diagnoses to their name, i’m actually pretty laid back about the big things in life and so i didn’t feel like the ivf process, in itself, phased me much at the time. with the benefit of hindsight though, i can see that there were some elements that i really struggled with and which were directly related to the eating disorder.

for a start, ivf treatment is predicated on you (and by you, i mean the woman) being at a normal bmi. when you’re trying to get away from measuring your self worth by your bmi (and when a lot of eating disorder treatment is based on you falling to a certain bmi), this can be hard. some people may have happily been in recovery for years and suddenly find themselves needing to drop weight, often pretty quickly. for others, like me, it means putting on weight. i basically binged myself into a healthy bmi. it did not help my mental state at all.

once you cross that first hurdle of actually being eligible for ivf, you have to face the fact that lots of people are going to see you with very few clothes on. of course, they’re all medical professionals and they see hundreds of vaginas a day but that doesn’t change the fact that you have to wander round in a flimsy hospital gown or lie on your back, legs akimbo, with five or six people staring intently at your naked body. in some ways, i found this part the easiest to dealt with (partly because i was always a bit more worried about triggering my ptsd but mainly because quite a lot of the procedures require a (very) full bladder and i normally had to concentrate all my energy on not wetting myself). but the fact remains that i am far from happy with my body and far from happy about having people see it. (side note: i was also self-conscious because of scarring from self-harm but that was generally ignored by everyone much to my relief). added to this is the fact that the hormones and all the follicles that grow inside you often lead to bloating (and weight gain) and you have a recipe for feeling shit about yourself.

clearly, for the ivf to work, you need to be eating three meals a day and eating a relatively healthy diet (there are also some other dietary suggestions they make – like lots of protein and full fat milk – which i tried to follow as much as i could). on the whole, i managed to eat regularly because i was so worried that my failure to eat would be the reason that the cycle didn’t work. it was, it goes without saying, hard particularly as you are advised to limit exercise both before and after transfer.

what i struggled with the most though was that the regime of drugs i was on required that i eat at certain times. there were some drugs that i had to take with food in the morning, some which i had to take on an empty stomach (ie at least two hours after eating) and some which i couldn’t eat for at least an hour afterwards. i had to take those latter two drugs three times a day. there are simply not enough hours in the day. so i was having to desperately force myself to eat or not to eat at certain times and i spent all day consumed with the thoughts about when/what i would next be eating. controlling my food intake is so deeply ingrained as a coping mechanism (particularly in times of stress) that to have it controlled by something else was, frankly, unbearable and it was also somewhat unexpected.

if this had resulted in a positive pregnancy test, i’d probably have a very different view. it will surprise nobody (least of all my psychiatrist) that i’ve stopped eating very much since we found out that the cycle failed. i was only really embracing recovery (to the extent that i did) for the sake of a future pregnancy and although this is certainly not the end for us, it seems that much further away now. my eating disorder is absolutely loving it.

obviously though, i need to be at a healthy weight for another cycle and i can’t cope with the idea of not giving the embryos that we have in the freezer the best possible chance of life. but there’s part of me that’s terrified of doing it all again (possibly with the same outcome) and so losing weight seems to be the best option. and so, yet again, i feel like i’m stuck in the middle of a war zone.

i know that we are incredibly lucky to have access to ivf treatment and, in particular, that we ended up with a fair number of high quality embryos so the odds are in our favour.  i certainly don’t take it for granted at all. when/if we go again though, i can only hope that, in the end, it’s all worth it.

be like a peacock and dance with all of your beauty

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it’s been over a month since i wrote here. it feels like a lot has happened in that month and most of it has been bloody hard work. an attempt to wean myself off sertraline ended in abject failure and a few weeks of feeling pretty fucking awful. as a result of that, the anorexic voice grew louder and louder until i was fully back into restriction and starting to lose weight again at an alarming rate. at the same time, our lives have been a little up in the air as our planned ivf cycle was delayed and we’ve been living out of a suitcase for the last month while we have some building work done. i also had a falling out with my therapist after she accidentally sent an email about me and my lack of progress/engagement to me, rather than to my psychiatrist who is in overall charge of my treatment. whilst it wasn’t a great feeling, i think it was actually helpful because i don’t think we ever really clicked and it gave me the push to say that i didn’t want to see her again. so now, i’m just working with my psychiatrist and my nutritionist which suits me much better as i like both of them very much.

so things, finally, seem like they’re coming together and i’m getting back on track. and it’s not a minute too soon.

last week, i spent three intense days on a leadership course. the focus was on finding the ‘real me’ to become an authentic and resilient leader (hence the peacock; it was a metaphor that appeared time and time again throughout the week).

i was cynical going in because it sounded like the kind of thing that i hate and i was also incredibly anxious about the change in routine and coping with having to eat with other people (spoiler alert: i didn’t). in fact, it was life-changing. so much resonated with me not just from a professional perspective but in relation to anorexia recovery. it helped to crystallise what is really important to me, what my core values, dreams and strengths are, and what i need to do to become the very best version of my self. which is what i desperately want to do.

at the end of the three days, we had to come up with our personal leadership vision; a few words that encapsulated where we want to get to. i thought i would find this a real challenge but actually it came to me quite easily: the freedom to make a difference. both at work, to my friends and family and to society. but in order to be able to do that, i need to get out of my head, be healthy and learn from adversity, rather than crumbling every time something goes slightly wrong and resorting to my usual self-destructive behaviours.

at the moment, there’s still a disconnect between this vision and my behaviours. the anorexic voice is still deafening and is winning through more often than not. but i’m more hopeful now that it won’t always be like this.

{title quotation from debasish mridha)

life is so endlessly delicious

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one of the goals that my therapist has set me for this week is to think less about food. this means less time on pinterest and instagram scrolling past pictures and automatically starting to calculate the calories. less time reading recipe books and food blogs, planning meals that i may or may not eat. less time looking at restaurant menus online, paralysed by hypothetical indecision.

the idea is that food – and everything i associate with it – is taking up too much of my time at the moment and forms far too large a part of how i view and value myself, leaving very little left for any other aspect of my life. every thing that i eat – or just think about eating – takes on far more signficance than it should. sometimes i can spend hours just trying to decide whether i should eat breakfast or not and what either of those decisions means about me (which, the rational part of my brain knows, is absolutely nothing).

like many people with an eating disorder, i love food. i’m obsessed by food. in some ways, i think this is a legacy of being a fussy eater as a child – i was always thinking about food and whether there would be something i could eat at the next meal. without wishing to sound like a twat, my husband and i have been lucky to eat in some of the best restaurants in the country over the last few years (including a spectacular pre-wedding meal at the fat duck) and i’ve been fascinated by every single ridiculous course.  for a while, this was channelled into the food blog i used to run which legitimised it. there was a whole community out there of people who spent just as much time as i did thinking about food. although i might have been free from some (or indeed most) of my disordered eating habits, that obsession meant that they were never very far away. and then, when life went to shit, they came back with a vengeance.

i do understand my therapist’s point of view. my life needs to be less dominated by food. but, at the same time, food is so bloody delicious and the idea of a life that doesn’t celebrate that seems pretty grim. i guess where i’m struggling at the moment is to find some sort of middle ground and so i end up swinging from one extreme to the other.

 

{title quotation from ruth reichl}

the world breaks every one and afterward many are strong at the broken places

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at one point last summer, i told my old therapist that i felt completely and utterly broken. from memory, he seemed to think that i was being a tad melodramatic which may well have been a fair assessment. i remember that feeling so acutely though; mainly because it’s almost exactly how i feel right now.

this morning i had an appointment at our fertility clinic for a couple of internal scans / procedures in preparation for our ivf cycle which will be kicking off in a couple of weeks. it was supposed to be relatively routine – no worse than a smear test i’d been assured – but due to a complication with my ‘flexible’ cervix (way tmi i’m sure) it was a lot more difficult and painful than anticipated. as nice as everyone was and as gentle as they tried to be, the whole experience was incredibly traumatic. i’m still struggling now and have spent most of the evening in tears.

in some ways, my feelings about infertility/ivf are not dissimilar to my feelings about the rape.  there are, clearly, areas where the two are intertwined (like the months where we haven’t even been able to try naturally because of my fear of flashbacks and intrusive thoughts) but, more than that, there’s a lot of guilt associated with both of them and the feeling that either – or both – are no more than i deserve. and then sometimes i think that the infertility must be my punishment for being raped.

both the rape and the infertility play neatly into the construction that i have built of myself; reinforcing the belief that i am fundamentally broken.

(when i was at university, i did a paper in my final year on tragedy throughout the ages going from the plays of ancient greece to beckett via shakespeare, racine and ibsen (amongst others). i think i might have taken the concept of hamartia slightly too much to heart.)

if you’d asked me a few months ago, i would have said that, with therapy, some time off work and a fair amount of medication, i’d managed to fix myself. but it turns out that the glue that was holding it all together was the anorexia. and without that, i’m broken again.

{title quotation from a farewell to arms by ernest hemingway}

sunday evening…the very time of all others…when the heart must be opened, and every thing told

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somewhere along the line, i’ve grown to hate sundays. sunday afternoons in particular. for reasons that i don’t quite understand, i find this by far and away the hardest time of the week; it’s often when the intrusive thoughts are at their strongest. i often end up hiding, retreating from the world and burrowing myself in the sanctuary of my bed.

today has been no different.

i’ve not been sleeping well recently. partly because i’ve stopped taking diazepam / olanzapine at night. but mainly because there’s just a lot going on at the moment. work is busy and stressful; last week involved some late nights and early starts. the ivf process kicks off this week with a dummy transfer on tuesday morning to check that everything will go smoothly for the real thing. at the end of the week, all being well, i’ll start on the pill for 10 days or so to regulate my cycle. i’ve had a welcome break this week from re-living the rape in therapy but it’s always there. and then there is still absolutely no respite from the constant and exhausting battle against the eating disorder voices. it’s so bloody noisy in my head right now.

despite all of that, i actually had a couple of good days this week. i managed three meals without any restricting or bingeing. and then. as ever, i self-destructed. not spectacularly, particularly in comparison to recent weeks, but it was enough. i was, perhaps, slightly ambitious in inviting some friends for afternoon tea yesterday. the combination of anxiety about eating and being surrounded by food left me drained by the end of the day. and more conscious than ever of how much this eating disorder is still controlling every aspect of my life despite things appearing, on the surface at least, to be much improved.

i woke up early this morning, bruised and fragile. i felt defeated before the day had even begun and certain that i wouldn’t be able to resist the lure of a day of restriction. but a run helped a little, despite the rain and the hills that i forced myself up. an appointment with my lovely nutritionist also helped, at least enough that i was able to manage some lunch when i got home.

one thing that we talked about today was the importance of preparation; anticipating the bad times and having a strategy in place to survive them. and so, it’s been a deliberate strategy this afternoon of curling up on the sofa and distracting myself with a trashy thriller. so far, it seems to be working.

{title quotation from mansfield park by jane austen}

stirring dull roots with spring rain

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on friday, my psychiatrist and i agreed some rules for april. unless i make what he described as significant progress by the start of may, he will suggest that we take a break from treatment and i consider my options. for the last few months, i’ve been stuck in a sort of half-recovery, doing just enough to avoid getting into serious trouble but not really trying as hard as i know that i need to.

the rules are simple. don’t lose any weight. three solid meals a day, totalling at least 1,200 calories. reducing the bingeing that has crept in to twice a week, max. no purging behaviours. basically all the stuff that ‘normal’ people do (except maybe the bingeing).

april needs to be the month that i crack this. partly because being kicked out of treatment (even if it’s done in the nicest possible way) will be (yet another) way in which i’ve failed but primarily because we’re hoping to start ivf this month. my missing period turned up over the weekend so i need to call our clinic tomorrow morning to get the ball rolling; a prospect which is both more terrifying and more exciting than i can put into words.

sadly, yesterday – the 1st april – wasn’t much of a success. it was perhaps slightly ambitious to try and stick to the agreed rules and host easter lunch for my in-laws at the same time. at the moment, any kind of social occasion – even one in my own home which i am firmly in charge of – generates a huge amount of anxiety which generally translates into all the behaviours that i’m not supposed to be engaging in.

it astonishes me that we’re in april already. the year is slipping past, lost in a blur of bingeing and restricting and purging. i don’t want to go on like this. today is going to be a better day. it has to be a better day.

{title quotation from the wasteland by t.s.eliot}

i’ve seen more battles lost than i have battles won

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in the week before easter last year, i found out that the cps weren’t going to prosecute my rapist.

there were a multitude of reasons for this, many of which i fundamentally disagree with but there was nothing more i could do to change their minds. after two years of fighting the police (thankfully not very often), the cps (most of the time) and, ultimately, the man who raped me, i lost. sure, i didn’t go through the hell of a trial (at which, i’m fairly confident, he would have been found not guilty) and didn’t end up with hundreds of commenters on the daily mail accusing me of making the whole thing up but still, i lost.

and he won.

he raped me and he got away with it.

and when i realised that i had to stop fighting him, i started fighting myself. i’ve been consumed by that fight ever since; i have the literal and metaphorical scars to prove it. although he knows nothing about it, he’s still winning. and that really has to stop.

{title quotation from the queen and the soldier by suzanne vega}

the beginning is always today (part ii)

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a couple of years ago, i decided to cultivate a little garden on our balcony. this turned out to be much more challenging than expected. we didn’t get much more than seven raspberries (which i turned into donuts, obviously). my mother-in-law made some valiant efforts to help but for the last couple of years, it’s been pretty barren out there bar a rosemary plant which i was assured was indestructible but which i’ve been doing a pretty good job of slowly torturing to death.

yesterday seemed like a pretty good day to get back out there and plant some things.

my best friend texted a couple of days ago to ask how my week had been. it’s been hard, i said, but they’re all hard. and they really are at the moment. for every few moments where i feel like i might actually beat this, there are hours of despair, self-loathing and shame.

this week has been even more up and down than usual (as evidenced by the fact that the number on the scales has been ricocheting around). we had an appointment at our fertility clinic and got the go-ahead to start ivf when my period arrives. which is great except my period is currently awol. my doctor thinks that the stress of the last couple of months and the extreme cycles of bingeing/purging/restricting have caused it to disappear. i need to get it back asap. for a little while, focussing on the needing to eat healthily for a potential baby give me some much needed motivation but i soon (ie within a day) slipped back into my old habits. this led to a difficult – but ultimately beneficial – session with my psychiatrist who put some firm ground rules in place as to what i need to do in order to continue with treatment otherwise he’ll discharge me. surprise surprise, i’m a perfectionist who likes structure and rules so i’m actually grateful to him for being ‘mean to me’ (his words, not mine).

there have been many new beginnings. i can’t tell you how many times in the last couple of months there has been a day 1 (after the official day 1) or an email from my therapist that ends with some form of ‘don’t worry, tomorrow is a new day’. but it does sort of feel that something has started to change over the last few days.

i was going to blog yesterday about how it was a fresh start and i was really committed to doing what i need to do (three meals a day, no restricting, no bingeing and definitely no purging) and everything was going to be different this time. but i decided not to because i wanted to see if i could actually do it or if it was yet another false start.

but i did it (just about).

for the first time in a long time, i did have three meals. and although i had a bit more chocolate after dinner than i probably should, i shared it with my husband (rather than bingeing in secret). every minute of the day was hard and i really had to fight for it but i managed it.

and then, i had a really good appointment with a nutritionist today. her enthusiasm and positivity was inspiring. for so long, i’ve been stuck in the past, re-living the night that everything changed. the idea of a future – and a happy one at that – has seemed so far away that it’s not something i’ve ever even been able to contemplate. but it feels a tiny bit closer this afternoon. i know this feeling won’t last forever and my capacity to self-destruct will kick in sooner or later but i need to believe that i can and will feel it again and every time that i do, i get a little bit stronger.

{title quotation attributed to mary shelley}