Tag Archives: anorexia

How do I get to the point where I want to recover?

Having written about being ambivalent about eating disorder recovery, this is a natural question to ask.

For people who don't understand why someone with an eating disorder wouldn't want to recovery, please read here.

It was my ambivalence to eating disorder recovery that got in the way of a lot of therapies that I tried. I would put all my energy into the therapy but recovery just wasn't happening because, underneath it all, I didn't want to recover.

I was very fortunate to come across a therapist who asked me "do you want to want to recover?" No-one had ever asked me this, no-one had ever said, no matter how long that sentence is, if you want to want to want to want to recovery, that's a good enough place to start.

So many people find themselves in limbo, they have a sort-of-life mixed with sort-of-functioning-anorexia. But still they wonder about recovery, what it is and what it could look like but remain stuck.

Ok, so if we establish that there's a small bit of you that's interested in getting to the point where you want to recover, it's about looking at what makes you want to get to that point?

I can only talk about my experience. I'll be honest, every minute of every day, while I was unwell, my interest in recovery fluctuated. It wasn't a smooth linear progression and there's no point in pretending it was, this wouldn't be fair.

I did a few things throughout my recovery:

I was honest about why I was holding onto my eating disorder:

  1. I rated thinness over everything else in life.
  2. Getting fat (restoring my weight) felt impossibly terrifying.
  3. I kept me "safe" – I could avoid social events etc.
  4. I could be excused from life whenever I wanted.
  5. It gave me a framework for making decisions (i.e. choosing foods on the lowest calorie content and doing activities that used the most calories).
  6. I liked the identity and I didn't know who I'd be without it.
  7. Recovery looks too hard.
  8. I'm such a bad/evil/fundamentally flawed person, I don't deserve recovery/happiness/freedom.
  9. I thought I'd done too much damage to myself and my life to bother trying.

Once we're honest with ourselves, we can start to be curious about what it all means.

I looked at the negatives of being unwell:

  • I wasn't taking a full part in life.
  • I was letting people down.
  • I experienced poor physical health (tiredness, coldness, lumbago, anaemia, aches and pains).
  • The only thing that made me happy was the number on the scale going down.

I thought about what professionals were telling me:

  • I was unwell (even if I didn't think I was).
  • I was damaging my body.
  • I was putting my life at risk.
  • Recovery was possible.
  • A better, more for-filling, happier life was possible and I deserved it.

I thought about how arrogant it was of me to rate my thoughts and beliefs above those of the professionals. If I ever didn't think I was sick enough or thin enough to deserve treatment, I thought of all the people who were sitting on waiting lists and realised the professionals wouldn't waste their time on me if I didn't need or deserve their help! I often checked out with professionals if they wanted to see me, probably sounds hideously manipulative but I needed to know they really wanted to help.

I imagined some positives of recovery:

  • I'd discover who I really was.
  • My physical health would improve.
  • I could enjoy "bad foods" – actually, maybe no food would be bad!
  • I could go on holiday/eat out and fully participate without fear.
  • I could help other people recover and believe what I was saying.
  • I'd choose a life I wanted rather than one anorexia dictated – this was really scary since I had no idea what I wanted but I had to have faith this would come

I looked at whether my reasons for holding on were valid:

  1. I'd be happy if I could rate something else over thinness (I didn't know what it would be but the possibility of valuing something else was appealing)
  2. The reality is, weight restoration is not about getting fat (even if Ana screams this everyday). Weight restoration is purely and simply about nourishing my body adequately for health
  3. What is "safe" about starting myself? (Yes, it feels psychologically safe but in reality it's killing me)
  4. I could learn assertiveness so I didn't have to use my eating disorder as an excuse.
  5. Learning my likes a dislikes could be exciting! Instead of choosing an apple due to it's calorific value, I could choose chocolate, just because I fancied it!
  6. As scary as losing the 'ill' identity was, the reality of people feeling sorry for me or treating me differently was tiresome. Recovery could give me the opportunity to choose an identity. I could be defined by my job, my achievements or my hobbies.
  7. Yes, recovery is hard but I had people offering help and they were telling me I was strong enough to do it.
  8. I had people telling me I did deserve recovery. If I was such a bad person, why would anyone stick by me?
  9. Continuing to think "what's the point of trying" just isn't sustainable. I tried this a few times, i.e. Disengaging with services etc but it doesn't have a happy ending.

It's very common for people with anorexia to feel they're not sick enough to start recovery. Sufferers feel they've not been a "good enough" anorexic if they've not been tubed or not reached a certain BMI, but everyone's experience is different. It's always worth considering what you'd say to friend in this situation. If they were saying "I'm not sick enough", would you say "yeah, you need to lose more weight, eat less, exercise more, then you could consider recovery"???

It's not simple or easy but going through this sort of process might help when trying to get to the point of wanting to recover. Everyone's different and will have different motivations so it's important to go through the process for yourself, not comparing yourself to anyone else.

I found I had to choose recovery everyday. Some days this was harder than others and some days I chose to be ill but every new minute gives us an opportunity to choose recovery, to choose wellness, to choose to definite ourselves differently.

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My thoughts on To The Bone new Netflix movie

The much anticipated movie, To The Bone, has provoked a lot of attention from people within the eating disorder community.

I would prefer it to have caused more of a stir in people who have no experience of eating disorders but are they going to be the people who watch it?!

It’s so hard that so often, when trying to raise awareness of mental illness, we end up preaching to the converted and it ends up being more about whether it’s been a typical representation or whether anyone’s offended or triggered by it.

What I want is for people who do not know anything about eating disorders to watching this film. It doesn’t show the whole recovery story but it does show the difficulty coming to terms with needing treatment.

People within the eating disorder world are putting people off from watching it, this is probably their aim. I’m not quite sure why other people think their story “better portrays” anorexia or why it’s ok to deliberately trigger yourself and then lash out at the film’s leading lady or director.

By it’s nature Hollywood is glamorous and stories are simplified for entertainment purposes. If we want to use a widely accepted form of media to raise awareness, we have to accept these compromises.

This film will do more to get conversations going than any blog writer and I’m happy to thank them for doing it.

Please don’t watch it if you think you may be triggered, it really is that simple. I know it may not be easy as in recovery we’re all ambivalent but it is a simple yes/no desision about whether to watch it. Maybe shut off social media for a few days to let the hype die down and every time you’re tempted to click yet another To The Bone link, say “no”.

Read more about my thoughts on my Metro blog

The ambivalence of eating disorder recovery 

It’s really hard for people who’ve not experienced an eating disorder to understand the pull towards destruction.

Ambivalence…the coexistence within an individual of positive and negative feelings towards the same person, object or actions, simultaneously drawing him or her in opposite directions.

When your life’s completely falling apart, you’re not able to hold down and job, you’re losing friends and you’re feeling physically unwell, how could anyone not grab hold of recovery with both hands and run with it?!

If, however, you’ve lost everything else, the only thing you have left becomes your identity and a place of safety. If you feel like your eating disorder is the only thing you have in the whole world, how could you possibly consider letting it go?

Eating disordered behaviour not only becomes habitual but it’s a compulsive addiction.

Weight restoration is a significant part of anorexia recovery and this, for me, was terrifying. Having spent years trying to lose weight, put my body through all sorts to try and obtain the unobtainable skinny body of my dreams, thinking about throwing all that work away is unbearable. All the professionals who claim they have my best interests at heart are trying to make me fat, how could they not understand that’s the one thing I can’t do?!

It feels impossible to understand when you’re told “you have to put on weight before you can engage with therapy”. Once your weight is below a certain level and you’re body is malnourished, your brain is not receiving enough energy to function to do everyday tasks, let alone process and absorbed any new understanding in therapy.

“But I can’t gain weight unless my head is straightened out”… this feels like an obvious plea as multiple professionals are telling you your medicine right now is food. “How am I mean to eta when every fibre of my being is telling me not to eat?”

That is what anorexia does, it takes over every fibre of your being, it infiltrates every cell and permeates every breath you take. It feels like you become anorexia. I didn’t feel like I existed beyond my anorexia therefore doesn’t it make sense that I wouldn’t want to let it go? That’s the impact it has, that’s what it makes you believe, anorexia is your identity, without it you are no one, you do not exist… 

Now, I didn’t want to exist, part if my anorexia was about losing so much weight that I would disappear but there was a tiny part of me hanging onto life. In an odd way, although anorexia was killing me, it was also enabling me to hang onto life. When i stopped and thought about my life and what a mess it was, ending my life was an appealing option but focusing on avoiding food and losing weight gave me a purpose.

The first step towards recovery is putting more faith in the people around you than in the anorexia that’s been with you for many months and helped you cope with all that life throws at you. This is quite a tall order. The leap of faith feels impossible.


As I started making progress towards recovery, it felt like the anorexia fought back, as though, it felt threatened. The voice I heard in my head began shouting louder, it continued to tell me I had to lose weight. How do you keep following the meal plan when day in, day out, you’re being told how fat you are, you’re eating too much, your greedy and you should engage in all behaviours to lose weight?

I had so many questions, if let go of my anorexia, who will I be? What will I do? What else will I think about? It felt like I would be nobody and I would be completely empty but as my recovery journey developed, I learnt who I was and things naturally became part of my life. 

How could I stop weighing myself multiple times per day?…then I wouldn’t know how much I weigh

How could I start eating chocolate?…what if I enjoy it?

How could I eat food if I didn’t know how many calories were in it?…then I wouldn’t know how much to restrict the next day

How could I stop exercising?…how would I know how much food I’d earnt?

I confess, when I was in a full blown eating disorder intense recovery programme, I would engage in searching for the web for hints and tips about how to “stay anorexic”, how to stop the hunger pangs without eating, what foods had the fewest calories, how to exercise when exhausted and on the verge of fainting, it’s all there and it’s down right dangerous.

The ambivalence is unbearable, desperately wanting to recover but also, desperately not wanting to recover. I could see the pain I was causing those around me, I honestly did want to recover so I could live a “normal” life but at the same time, I wanted to lose more weight and cling onto certain aspects of my anorexia.

The lack of energy you have when starving yourself makes the fight even harder. The recovery journey is tough and the tougher it gets the easier it feels just to stay indulging in anorexic behaviour. It gets even scarier when you get to the point when anorexic behaviours arent second nature anymore, what now? I thought, “if I’m not anorexic but I’m not recovered, what am I?”. At this point the feelings of failure are rife. Feeling like a “failed anorexic” is all too common but feeling like you’ve failing at life is also a tough obstacle to overcome. At this point, it feels like there’s no way back but the way forward feels equally impossible.

I did make it though, I did put faith in the professionals, I started listening to my body, when it was hungry I would feed it, when it was tired I let it rest. The signals are mixed at first, hunger pangs are confused with feeling full, tiredness gets confused with a lack of motivation. I found it really hard, I’d spent so long ignoring my body I had a brain-body disconnect so initially trusting the professionals and going through the motions was all I could do. I had to trust that they’d been through this more often than I had! It does help when you hear it from people who’ve actually lived through it, when recovering I found it helpful to speak online to people at various stages of recovery.

For me, therapy was the most important part of my recovery but it couldn’t have engaged fully in it until I was nourishing my brain fully. I tried to kid myself that I could sort my brain out while still starving myself but I was wrong.

I may not be totally happy with my body but now I nourish my brain I’m able to think more objectively about it and see that now, my life is full of all sorts of other things that wouldn’t have had space if I’d not let go of my anorexia.

This is my dream

This year’s theme for Mental Health Awareness Week is Surviving or Thriving. I absolutely love this, to me it’s making the point that so many people miss. Getting through a mental illness is all about surviving, surviving the illness itself, surviving what the illness takes away from you, surviving the mental health system and more. 

But once on the road to recovery (which I truely believe is possible for everyone) it really is about finding how to thrive. Many people get stuck in survival mode and I want to cry out to them, you can do better, there is more out there for you, I promise.

I want to be an example, dare I say, an inspiration, that survival in possible.

When your mind is sick and all around you is black, it can feel like there is no hope, like you’re all alone and no one has ever felt as bad as you feel before. I have been there, I have been in deep dark depression and debilitating anorexia. At times I’ve been so stuck in my head my behaviour has made no sense at all. I’ve been in that place where you make the same mistakes over and over again, desperately hoping something will magically solve itself.

But I survived, I fought my way to freedom.

It is wonderful to be positive about the possibility of freedom from mental illness but sometimes there’s an added dimension that makes recovery far harder than just taking medication and forging a few new neural pathways (if that wasn’t hard enough!).

Eating disorders, in particular, are incredibly difficult to recover from because as they are a coping mechanism and therefore there’s a big part of the sufferer that does not actually want to recover. This can be really hard to admit, and nearly impossible for other people to understand. I argued with myself, I was going through hell, I hated what was going on, so, of course I wanted to get better but a big part of me was holding onto (what felt like) a safe coping mechanism.

So, I want to be a warning.

I have recently spent some time thinking about what my mental illness took away from me.

Sufferers are all too aware of how much we lose to our illness but at times we can be so embroiled in the thoughts, feelings and behaviours that we become blind to the scale of the impact.

Anorexia has the highest mortality rate of any psychiatric disorder, from medical complications associated with the illness as well as suicide. – Beat

I’m fortunate that I’m here to tell my story, however…

I have problems with my bones, colon and stomach, I have fibromyalgia and could be infertile. I have to have frequent blood tests which often show deficiencies and I continue to take medication and undergo other treatments including operations to manage the various conditions. Consequences other people face include ongoing liver, kidney or even heart problems, with eating disorders, no body system is left untouched.

If you or someone you know is struggling to break free, I implore you to do everything you can to find that tiny part that does want things to be different and hold on tight! Things will only be different if you try something different. 

Surviving mental illness takes effort, thriving takes something else!

Thriving at life isn’t easy, the truth is, life’s hard – I don’t think anyone would deny that! I have to work hard at the little things, being spontaneous, using the phone, knowing how to take care of myself, smiling when I have no energy and being socialable when I don’t want to. That feeling “stop the world I want to get off!’ – I get that a lot! But I’ve discovered the things I like, I know what makes me happy and I make sure I take time out of life.

When making my way back into the world of work I did some volunteer work to a) find out what I was good at and b) find out what I liked. Trying new things with no strings attached is fun and liberating! It became fairly obvious that my forte was going to be in the mental health world, my personal experience built on my background education. Since then I’ve been gaining experience in a variety of settings and more than anything I’m enjoying writing 🙂

There is no definition of thriving, you are not going to know when you’ve ticked that box and that can be tough! It’s a journey not a destination!

My dream is that people can see that I can recovered and have hope that they can develop their own version of recovery, I want those struggling with the pull of addictive behaviours to find the desire to break free and I want those stuck in survival mode to break free and find how to thrive in their unique way.

Survey reveals referral rates need to improve

As part of Eating Disorders Awareness Week, Beat, the UK’s leading eating disorders charity, asked nearly 1700 people, (1420 of which had an eating disorder, the others knew someone close to them with an eating disorder) about their experience with GPs.

I took part in this survey to get my voice heard and it seems many people feel the same way I do…

The survey revealed that half of sufferers rated their experience as “poor” or “very poor”. Of people who would have benefitted from immediate psychological support 3 in 10 were not referred to specialised services.

More than half of the sufferers felt their GP didn’t understand them and only one third (34%) thought their doctor knew how to help them.

Only 20% of patients came away from their appointment with information about eating disorders and services that could help them.

It will have taken many of these people months if not years to have reached the point of asking for help, the courage to make the appointment, get through the door and start talking about their problem would have taken such courage, to be turned away with nothing is very worrying.



Why is early referral so important? Simple – recovery rates improve.

Anorexia has the highest mortality rate of all mental illnesses and currently, of those who live, many remain chronically ill. The sooner someone is referred for specialist support the higher their chances of full recovery.

It is important to work out why these vital referrals aren’t happening…

I do not want to come across as GP bashing, there is no way that some of the most caring people in our society are deliberately denying people the support and treatment they need. Andrew Radford, Beat’s Chief executive believes medical students, hoping to become GPs, need more training. I went to medical school, the shear volumes of information you need to absorb is vast. Maybe it’s not just about “recognising the signs and symptoms” as Mr Radford put it, maybe there’s more to it.

When I went to the GP as a 15 year old, I was not referred. I was not given any information. I did not receive the help I needed. It was hard enough just getting through the door but there is no way of turning back the clock to find out why. Maybe I didn’t explain myself well enough? Maybe there should be more eduction in schools so I was more equipped when I went to my GP?

My experience was 20 years ago but the Beat survey reveals this is still happening today. Is it the “old school” doctors who aren’t keeping up to date with training? Do newer GPs need more training? Are GPs/secondary services using out-dated/overly stringent criteria as referral criteria e.g. BMI? Is there an inaccurately held belief that if you refer someone there’ll develop an eating disorder where there wasn’t one? Are GPs so overworked, although they know the signs and symptoms to looks out for, they miss them? Do they think, “if it’s that serious they’ll come back”? Do patients go with too many problems and the GPs are distracted by other issues they consider more important? Do doctors not have enough times to refer people? Are doctors unaware of what secondary care is available? Do GPs think the secondary care is inappropriate/unhelpful? Is the mental health stigma still getting in the way?

We really need to get to the bottom of what is going wrong in the consultations where people are not getting what they need.

Perhaps some positive news is that once some of the sufferers swapped GPs (as nearly 1 in 6 did) they reported receiving the help they needed. When I approached a GP in my 20s I’m very glad to say I’ve had much better support. By this time I was a lot sicker, my GP had to persuade me to access the secondary and then tertiary services, she was excellent. Since then, I’ve moved a couple of times and each time, I’ve had a mixed experience with GPs. It’s been very difficult to find what I need but each time, with some perseverance I’ve found a GP with the right skills and experience to support me. Maybe I am a tricky/difficult patient but I’m definitely not alone with these feelings as the Beat research reveals.


Somehow we need to make sure that every single one of the 725,000 people in the U.K. affected by an eating disorder gets the support and treatment they need to recover.

Please share your thoughts in the comments section below.

For more information:

Independent.co.uk

Full results of Beat survey

Confessions from a disordered mind

So, it’s eating disorder awareness week again and I fear, yet again, I will be “preaching to the converted”… not that I preach (I hope) but I fear my blog only reaches those people who already know about mental illness, those who are already interested, those who suffer themselves or who care for someone who is or has been mentally ill. People reading this do not really need their awareness raising, so…what’s the point?!

I’ve challenged myself to go a bit deeper this year. Maybe my audience are aware of mental illness, even aware of eating disorders and anorexia. But how many of you actually know what it’s like to be stuck on the treadmill of starvation where you beat yourself up because you wonder if you’ve chosen to be ill but when you try eating an apple, a voice tells you “if you don’t cut it into 36 pieces, you’ll put on 6 stone”?

Anorexia isn’t about choosing not to eat or just liking healthy eating. It isn’t sexy or glamorous. It isn’t about losing a bit of weight, being a moody teenager, being awkward or deliberately deceitful. It’s a serious mental disorder where your every waking moment is driven by a desire to lose weight and your nightmares are dominated by fear of fat. The interlinking of thoughts, emotions and behaviours and your interpretations of these is incredibly strong, it can feel impossible to break the automatic cycle.


The voice (I later called Ana) was with me 24/7, in bed, at the supermarket, while with friends, when I was alone, she never left me alone. I thought she was my friend as she gave me hints and tips to achieve my goal. She persuaded me to make trips to a supermarket that was further away because they sold products lower in fat and sugar. She kept me going when I slowed through exhaustion while out running, she made me run faster, harder, further. She helped me say no when I was tempted by cakes and biscuits. She made me walk instead of use the car, even when the weather was cold and wet. She gave me a buzz when I lost weight but didn’t let up, she made me strive for the next target.

With anorexia I was devious and deceptive. I’m ashamed of some of the things I did. This is common. My focus became losing weight, my aim was to consume as few calories as possible and use up as many as possible. Continuing with a vaguely normal life became difficult, impossible at times. I’d pour milk into a bowl to pretend I’d eaten cereal. I’d say I wasn’t hungry when my stomach was in knots. When offered food, I’d say I’d already eaten when the truth was I’d not eaten for days. On one hand I hated wasting food, on the other, I’d throw food away. I hated lying but if I was to achieve my goal I had to. Unfortunately, the more weight I lost, the more I had to hide. I also self harmed, I had to hide this as well.


Why was I so determined? I felt out of control of my body (during puberty) and of my emotions. I’m a highly sensitive introvert who felt like I didn’t fit in the world. I thought my food intake and losing weight was the only thing I could contol. As with any other coping mechanism we use to make ourselves feel better/happier (smoking, shopping, drinking alcohol) there comes a point where they stop helping and start becaming a problem in themselves.

The more weight I lost, the better I felt about my body, I got a pleasure, I felt a a sense of achievement. But each time I achieved my goal, I had to set a lower goal weight. The lower my goal weight, the harder it was to achieve. The harder I had to work at my eating disorder (yes, it’s hard work) the more unhappy I was. Anorexia is full of contradictions.

There came a point when I realised my goals for life weren’t compatible – I did not have enough physical or emotional energy to be the person I wanted to be and to continue losing weight. I had to decide which I wanted more. Unfortunately, it’s not as simple as just choosing to recover.


When trying to recover the juxtaposition of desperately wanting to get better with desperately wanting to continue losing weight (because you know you feel better lighter and feel worse heavier) is an impossible battle. It didn’t make sense to enter into a recovery programme, signing up to gaining weight, knowing this would make me unhappy. I was unhappy with my life dominated by thoughts of avoiding food, avoiding social situations involving food and constantly trying to use up excess calories, I knew I would be unhappy gaining weight and feeling excess fat on my body. This is a very difficult experience to explain.

As I wrestled with recovery, there were so many reasons to fight to get better but anorexia is powerful. I needed people around me with a lot of patience. Recovery is never a smooth journey and there were many hurdles and many set backs but it is possible.

When I tried talking about the voice I heard I was asked to give it a name (a well established therapeutic technique) but I insisted on calling it Frances because I knew rationally it was me… it felt like someone else but I knew this wasn’t actually possible. In an odd way, my insight was working against me.

Once I gave in and called her Ana, it became easier. Instead of blaming myself, feeling angry at myself, beating myself up etc…I started aiming all my anger and frustration at Ana and started fighting against my illnesses instead of against myself.


Is life plain sailing now I’m recovered? No, of course not! But, although I may never love my body, it is what it is and I make my own decisions now, I’m not dictated to by disorered thinking.

Is it a diagnosis, a label or an identity?

I’ve had a number of conversations over the years about the language used around mental illness – it’s complicated matter, made more complicated by people not knowing the power behind their words.

“I am not my illness”

I’ve had a gentleman with schizophrenia say they detest being called “schizophrenic”, explaining this by saying “you would not say someone is a cancer”. However, we are not saying he “is schizophrenia”, we would be saying he “is schizophrenic” just like we say someone “is diabetic”. However, I think what he was trying to express was that he is not his illness, he did not identify with his illness, he did not want to be labelled in this way and this is to be respected.


Even professionals use words derogatorily

If I said someone “is diabetic” I would not have any opinion or judgement on their personality or any other characteristics. However, I recently heard a paramedic say this patient “is schizophrenic” with so much power, bitterness and judgement, I could tell he was casting aspersions on this person’s character. I had presented my service users as a “56 year old gentleman with [a number of medical complaints] and schizophrenia” as information that may lead to conclusions about the current presenting complaint. While one person may be able to say someone “is schizophrenic” without any preconceived judgements, this paramedic was not one of them. Stigma in society is so strong, but it’s people who are being stigmatised that suffer, those doing the stigmatising don’t realised a subtle language change could have a powerful impact. With this small change, a person is not labelled as their illness but someone who has an illness.

“I am more than my illness”

Mental illness can have a negative impact on one’s identity. When I was diagnosed with anorexia I could have let this be my identity… i could have felt, I am not Frances anymore, “I am anorexic”. I have seen people so consumed by their illness, they may as well say “I am anorexia” – I am not a person anymore, I am an illness. But I did not want to label myself in this way, although it was true I was “anorexic” I preferred to see myself as “a person with anorexia”, then my character and personality traits could exist alongside my illness. It has been proven that assumptions about what it means to be mentally ill such as incompetence and inadequacy (commonly held) will lead to a vicious cycle of impoverished sense of self and low self esteem, ceasing to try and work or fit into society and poorer psychosocial outcomes and sustained symptom severity. (Read the full article here.) It follows that, if you identify as your illness, you identify as incompetent and inadequate, whereas if you consider yourself to have an illness, you are not your illness, you can distance yourself from these negative characteristics.

Of course, this is down to the individual and if saying “I’m bi-polar” or “I’m schizophrenic” does not impact on their ability to see themselves as separate from the illness that’s their prerogative. Or, if they want to be identified as their illness, that’s also, up to them. Perhaps I’m saying, from within a mental illness it can be very difficult to see the path to recovery, how you see yourself in relationships with your illness can be the turning point. In my opinion, recovery and turning away from being consumed by mental illness is possible for everyone (recovery may not mean cure – but that’s a subject for a different blog).

labels

When is a diagnostic label unhelpful?

I’ve had other conversations with people who think we should do away with mental illness diagnoses all together as the words can have such a negative impact on the experience. It can be very confusing when some words can be used by the general population, for example feeling depressed or anxious are valid and appropriate emotions, however, clinical depression and anxiety disorder are very different experiences, in some ways a million miles away from the basic emotion. For other diagnoses there are other problems e.g. the use of derogatory terms, such as “schizo” which has been used to mean “unpredictable criminal”. Personality disorder is a confusing term, we think (as society) we understand what is meant by personality so if someone’s personality is disordered, surely, their core being is fundamentally altered/damaged? Well, no, personality disorders are extreme complex and there is much discussion about changing the label to fit the experience better. But an individual experience of different personality disorders is unique such that everyone has a different perspective on which words would be more useful.


Of course, diagnoses are an essential part of communicating. It’s helpful if a collection of symptoms has a name so that treatment can be targeted appropriately. I have also had the experience of an inaccurate diagnosis being used which then had a negative impact on the treatment I received.

Language changes, this is normal

The word spastic used to mean “muscle spasms, a common symptom of cerebral palsy” – it is now an offensive term, because of how it was used, and has fallen out of use. The media may hide behind “the dictionary definition”, but if we follow this through, we can still use the word spastic, but we don’t. The ~”dictionary definition” of “schizophrenic” is “a person with schizophrenia” or “contradictory”, e.g. “the rehearsal was schizophrenic” could mean “frantic and disjointed” but this is as it’s at odds with the definition of diagnosis. Many people still think someone with schizophrenia has a split personality or they will definitely be violent…continuing to use the word in different contexts perpetuates this misunderstanding of the illness.

Just hoping people think about what they say…

It’s not hard to change, “schizophrenic person” to “person with schizophrenia”.

Breaking down stigma is vitally important in a cruel and judgemental world. Not realising the power behind our words can have a negative impact on those affected by the illness by perpetuate societies misunderstanding, judgements and stigma. Even if you do not mean offence by the words you use it can have more of an impact than you realise.

Another challenge ticked off!

As some of you will know I’ve written about my experience with anorexia and I’d like to share with you a recent hurdle I overcame and hopefully give people a little insight into the continuing recovery journey.

struggle

I’ve been “weight restored” for a few years now but the battle doesn’t end there. I’ve spent the last few years continuing with the challenges of eating different foods, eating in public, wearing different clothes and gradually I’ve accomplished each step, some falteringly, some more naturally with a lot of support. I would consider myself recovered but I had one thing left to do that I didn’t want to force, I had to wait for it to come up naturally and for me to be in a good place when it did come up!

Last night, I ate a main meal in public with people who aren’t close friends and/or family (it was a work social).

To a lot of people this is fairly standard and wouldn’t faze them but to an introverted recovering anorexia sufferer, this is the ultimate hell…but it wasn’t!!

I’ve previously done this with Steve (my husband) by my side. He provided a safety net should I struggle in any way. I know he would be there if I asked him to be, whenever I needed him. But last night, there was no safety net.

introvert

As a life long (there isn’t any other kind) introvert I’ve learnt how to manage social situations by putting on a bit of an act. As a child and young adult I would do this naturally as I’d automatically learnt to pretend I was someone I’m not to try and vaguely fit in. Once I realised I was doing this, I went through a bit of an angry stage, feeling annoyed that I had to be someone else to please other people. Now, I have peace with it – most of the time, I’m myself (quiet, reserved, choosing to listen rather than talk) but if necessary, I can use other skills (that are still part of who I am) to be a bit more “life ‘n’ soul”.

So, putting the introversion to one side, a short list of challenges lie ahead:

  1. Choose from a menu in a restaurant I’d not picked
  2. Engage in conversation (with people I don’t know very well) about food
  3. Not make any disordered comments
  4. Eat (a vaguely “normal” portion) while other people ate too
  5. Sit with any feelings that come up and not react unhealthily

Choosing food

I’m starting to enjoy going out for dinner with Steve but I’m usually at least 50% responsible for picking the restaurant. I’d had no say in this work social but no. 1 on my list wasn’t too hard as vegetarian options were limited (which I find helpful!) and they had a clear description of what they were under each heading. I still have calories, fat and sugar content swimming around my head but just picking something was the objective and I managed this.
Engaging in conversation

No. 2 isn’t too hard but combining it with no. 3 is tricky. It seems “normal” for women to be on diets and men to joke about it. I’m afraid I’m never going to be happy joining in with that sort of banter. I have 2 colleagues trying to lose weight and therefore avoiding carbs. At what point in history did carbs become “bad” and cutting out an essential nutrient become “good”? And I had a male colleague trying to get everyone drunk. I could join in the diet conversations with comments such as “you have to push past the hunger and see the pain as a good thing” but I think I’d get some funny looks! I work hard to join in other conversations and my imminent Kenyan safari holiday comes up. I’m very very happy to talk about that!

powerful

Portion size and eating

Food arrived in separate bowls and it was a case of serving yourself. Portion size is really tricky when you’ve had a voice yelling at you about individual granules of sugar or gram of fat and hunger signals have become unbalanced for many years. 1 table spoonful of rice can look like an overwhelming large portion to someone with anorexia so I still tend to glance at what other people are doing to judge what’s a “normal” portion. This doesn’t always work as normal doesn’t actually exist! But, fitting in with an average portion was possible! I sometimes struggle eating with other people if they’re particularly messy, or eat particularly fast, or slowly but I sit with these feelings and it’s ok. I didn’t have a voice yelling at me I wasn’t allowed to finish my dish (as that would be greedy) or social etiquette yelling at me it’s rude to leave food. I just ate what I wanted and left the rest. No. 4 executed while sustaining numbers 2 and 3!

ticks

Sitting with feelings

Feeling exhausted by this point but a very good sign is that my cheeks are aching from laughing and smiling so much. I’m not too full but I’m very glad there isn’t the shall I/shan’t I? question over dessert as my colleagues are going on elsewhere to continue drinking while I go back to work so the evening, for me, draws to a pleasant close. I’m please with how the evening’s gone so I can tick off no. 5 too!

Feeling accomplished!

hooray

Low self esteem: The hidden condition

Low self esteem can be a painful condition and many of us suffer in silence, unaware of the damage being done, unaware that there is a way out.

Throughout my mental health journey, I was asked numerous times if I had low self esteem, I would struggle with this question. The definition of self esteem is:

“Confidence in one’s own worth or abilities; self-respect”

Since I did not believe I had any worth or abilities, how could I possibly have confidence in them? I did not believe there was anything about me to respect. Therefore, the question baffled me because if there is nothing to feel good about how could I rate it as low or high? It’s only since my self esteem has improved have I realised how rock bottom it was and I had previously been viewing myself through a distorted lens. Once the cycle of low self esteem started, add in mental illness and you soon reach no self esteem!

We build a picture of ourselves and  our self esteem grows from a combination of the following:

  • Experiences at home, school, work and in the community
  • How other people react to you and treat you
  • Illness, disability or injury and how those around you cope
  • Your own thoughts and perceptions
  • Culture, religion and societal status and role
  • Media messagesself esteem boxes

Problems associated with low self esteem include:

  • Feelings of fear and anxiety – an all consuming fear of doing something wrong, looking stupid.
  • Isolation and avoiding new situations – these things can feel too overwhelming when you assume you won’t be able to cope.
  • Staying quiet and not sharing thoughts or ideas, not initiating conversation – anything to avoid looking bad, stupid of inept and avoiding rejection.
  • Underachieving and lacking ambition for fear of not coping or being rejected,
  • Or overachieving – constantly working inordinately hard to prove worth and competence to self and others, striving for perfection and perceiving failure if it’s not achieved.
  • Seeking or remaining in destructive relationships through fear of not managing alone.
  • Depression – persistent low self esteem with negative self-talk can lead to other symptoms of depression such as low mood, not sleeping, poor appetite etc
  • Hypersensitivity – assuming negative thoughts from others leads to being on the look out for these signs that confirm these fears. These could lead to acting on a sign that wasn’t perceived accurately (for example a compliment will sound sarcastic). Sometimes people will throw out “tests” to see what people think of them.
  • Lack of assertiveness – anxiety and fear can lead to difficulties sharing feelings and asking assertively for needs to be met. This can lead to people being passive and being “walked on”, which can lead to a build up of pressure and aggression being expressed as being defensive, sarcastic, brusque or even rude. Putting other people down (not necessarily deliberately maliciously) may be a way of covering up a low self esteem. Being passive-aggressive is common, examples include being manipulative, planned tardiness, throwing out cues for others to pick up on and gossiping.
  • Obsessions or addictions can be a way of coping or covering up. From workaholic behaviour through to developing serious mental illness such as anorexia or obsessive compulsive disorder with intrusive thoughts etc
  • Behaving in a needy way, relying on others for direction and trying to please others.

None of these are meant to be criticisms but it’s helpful to know that people behave in all sorts of ways, unintentionally, in order to manage such a negative feeling. It may be helpful to realise that you have low self esteem and that how you’re managing it is having a negative impact on you and the people around you. If you notice other people’s behaviour is annoying, unhelpful or irrational, this may be the tip of the iceberg and it might be worth thinking about whether their self esteem is playing a part, the real root may be hidden.

My lack of self esteem was mostly internalised and exaggerated as I turned to self punishment.

self esteem not good enough

I became depressed, used self harm to manage my emotions and hid inside anorexia to manage strong negative feelings about myself. Once I was on my road to recovery and I was able to reflect on some of my unhelpful thinking I became very aware of my fear of arrogance – my overwhelming fear of my head being too big had pushed me so far in the other direction I was suffering for it! A balance is important. (Arrogance is unattractive, and while some people may think it’s got them places, I never want to venture down that path.) I can be assertive while using humility to keep arrogance at bay!

It is really important to boost your own self esteem and the self esteem of those around you and to avoid unhelpful coping patterns. Here are some tips:self esteem don't compare

  1. Stop comparing yourself to others – a trap a lot of us fall into, thinking it helps us know where we stand but it’s unrealistic as we’re all unique with different abilities and strengths. Get to know yourself rather than thinking you need to be the same as someone else.
  2. Don’t strive for perfection – some people believe only God is perfect, others believe it does not exist. Being OK with “good enough” was one of the best things I ever did for my recovery. Don’t get me wrong, I love my perfectionistic streak (it’s part of who I am) and I can turn it on if I want to but I keep it in cheque!
  3. Make mistakes – it’s natural, it’s the way we learn and it’s fun! They will happen, there’s nothing we can to avoid them so we may as well enjoy them! Apologise if necessary, learn what we need to, treat yourself with compassion and move on – that’s the most important bit!
  4. Focus on the things you can control – focusing on our worries and the things we can’t control leads to a downwards spiral of negativity. Instead, if we look at what we CAN change not only will we feel better but we’re more likely to actually achieve what we want.
  5. Talk to yourself in a positive way – imagine recording a repeater tape with “I’m no good, I can’t do this, I’ll never achieve anything” – if you didn’t believe it in the first place, you will after a very short time! This is what goes on inside the head of someone with low self esteem. Instead, we need to replace it with “I can do this, I’m an OK person” etc. Work out what you want and tell yourself you can do it! If someone you know has low self esteem, make sure you are their positive repeater tape – without prompting tell them they are lovable, tell them what they’re good at, tell them they’re unique.self esteem be careful
  6. Do things you enjoy and help others do the things they enjoy – having low self esteem makes you focus on the things you’re no good at. For once, just relax and do something you know you’re good at – go to the park and read a book, spend some times stroking your cat, make a smoothie, do some weeding. Anything! Helping other to find something they enjoy has its rewards – it will improve their self esteem and you might find something new and fun too!

self esteem you are good enough

Breaking out of low self esteem can be hard. It’s especially hard if its become habitual to behave in these ways over years and years. But improving self esteem will improve every aspect of your life! Feeling better about yourself will mean you will be able to:

  • Communicate better, which in turn improves relationships, from intimate relationships to work colleagues to acquaintances.
  • Manage challenges better – challenges come along, they can defeat us or make us stronger depending on how we approach them.
  • Managing illness better – one of the biggest improvements I’ve seen is that when I’m unwell I’ve started asking for what I need instead of assuming I don’t have a clue and hoping other people will know better than me!
  • Get what you want out of work – being honest about whether you want to achieve highly, be a CEO or whether you want something else – don’t let your self esteem dictate whether you over or under achieve!
  • Have a healthy work-home-life balance – everyone’s different and needs/wants different things out of life. We should not allow our self esteem to allow us to be dictated to by others. Working out what works for us as a unique individual is vital for a healthy life!

If low self esteem is caught up in mental ill health, external support will be vital, recovery is tough but I wouldn’t give up my journey for anything. I’ve learnt so much about me and those around me, my life has been enriched by the experience. Wherever you are on your journey or whether you’re journeying with someone else, I hope my blog has helped in some way.

self esteem just be yourself

Not sick enough

Imagine you feel so overwhelmed by your feelings that you cope by cutting down on food…
Imagine that as you lose weight you start to feel a bit more in control and a bit better…

Imagine that you start hearing a voice that tells you to eat less and less…

Now imagine the voice shouts at your when you eat, tells you you’re stupid, fat, lazy…

Imagine that the only thing that makes sense in your life is not eating and losing weight…

Imagine that one day you start to feel scared of this thing that once made sense…

Imagine that you think you might need some help because you’re scared of your thoughts, scared of this voice, scared that you might actually be unwell. You’re scared of getting help but you’re more scared of not getting help…

Now imagine, you’re told, you’re not sick enough, your weight is too high, you’re not skinny enough to get help…

Now, that voice will scream at you even louder because not only did you consider fighting back against the voice but a professional has actually agreed with the voice that you should be skinnier…

This is what is happening up and down the country because the NHS doesn’t have enough money to help everyone and they have to find some way of deciding who they can help.

This is a crisis within the NHS.

I was tossed from service to service with a number of different mental health difficulties…on numerous occasions I would admit that I wasn’t eating or that I was making myself sick or doing a number of other disordered behaviours but my BMI was never quite low enough for that side of things to be taken seriously. When it finally was, I was offered “psychoeducation” (would you believe my computer wanted to change that to “psyched inaction”?!) because my BMI was 17. My BMI had to drop below 15 before I was offered more intense support. I did not deliberately drop my BMI to get the support, it was something that naturally happened because I was ill, I didn’t understand what was going on and no amount of “education” about what my body needed was going to stop the tourment inside my head that told me I was stupid, fat and lazy and had to lose weight at all costs. If, however, I’d been offered more intense support earlier, I know I would have recovered more quickly and cost the NHS less as I would have needed fewer therapy sessions to undo the extra damage that had been done.

These barriers to treatment are a false economy. Assessing anorexia and other eating disorders on physical signs alone does not take into account the fact that there are complex mental elements to the disorders. Mental health services need more funding so they can:

  • Stop only treating the critically physically ill
  • Treat everyone with a mental illness who needs it, when they need it
  • Support people for as long as they need it instead of cutting treatment short

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