Pull up a soapbox

Yesterday the New York Times posted an article on the issue of recovery from anorexia – specifically, if full recovery is possible, and if so, what that would look like. Then today, the Independent posted an article entitled “Is depression actually good for you?” I had the exact same response to both of these articles: “WTF?!”, followed by “well…actually…”

It can be dangerous for journalists to publish material like this, because if the issue is not handled sensitively it can give the wrong impression to people who suffer from mental health problems and the general public alike. For example, someone struggling with anorexia who reads the first article might just decide that fighting the illness isn’t worth the effort if full recovery isn’t possible. I am thoroughly sick of hearing from various sources that “once you have an eating disorder you will always have an eating disorder”. If someone with a history of eating disorders is still bingeing, restricting, counting calories obsessively, unable to participate in social occasions which involve food, or subject to random panic attacks about food and weight then that doesn’t mean that recovery is impossible, it just means that those people are not yet recovered. They might be suffering from a subclinical eating disorder, or from EDNOS, or from a form of disordered eating – but merely not looking ill does not indicate that you have taken recovery as far as it can be taken. Being recovered means not only looking healthy but acting in a way which is likely to keep yourself healthy and being okay with that mentally. Maintaining a healthy weight, not counting calories, being able to participate in social occasions which involve food, not being tormented by your weight or intake, not immediately restricting or bingeing whenever you go through a stressful period, not obsessing about food or numbers – those are not impossible goals. I resent any implication otherwise.

On the other hand, if I were to write that article, I would suggest that not only do some people not recover fully due to their personal circumstances (lack of treatment or support in the community, recurrent stress or trauma, physical illness, complicating factors like that), but that the discussion over whether full recovery is possible is a lot more nuanced than that. It really depends on how you see the illness. If you see it as an expression of emotional difficulties alone, then you may believe that resolving those difficulties will lead to full recovery. If you see it, as I do, as a complicated illness in which biology and environment interact with each other to predispose, trigger and maintain the illness, then you might believe that people can appear to be fully recovered, only to relapse after a significant period of stress or illness – anything which leads them to eat less than usual or lose weight unintentionally. However, that isn’t the whole of my opinion, because it suggests that the predisposed person is a helpless onlooker. In fact, because I KNOW I am biologically vulnerable to eating disorders, I can stop myself from relapsing by taking extra care of myself when I am ill or under stress. I can push myself to continue eating if I lose my appetite due to anxiety, or seek professional support if I find external circumstances too much to cope with alone. So in either case, whether you see eating disorders as purely psychological or a combination of biological and psychological, recovery without relapse is possible. I always think the saying “It will be okay in the end. If it’s not okay, it’s not the end.” is a bit misleading, because lots of people end their lives in pain and suffering, but in the context of recovery it IS true. If you’re not fully recovered, you’ve not reached full recovery – but that doesn’t mean it doesn’t exist.

Jumping on soapbox number two: the article on depression. I do see the journalist’s point, which is that some people find that depressive episodes can act as a catalyst for change. For example, if your depression is caused by overwork and physical/mental exhaustion, then becoming depressed would show you that you are pushing yourself too hard and it might influence you to take your life in a different direction. Another point was that some people find that once the episode is over, the things they learned from the illness and recovery mean that they feel stronger and more capable of coping with future stress. But whilst those are both valid points, they are both pretty limited too. In the case of the first example, what if the depressive episode came out of the blue? What if it was merely a biochemical fuck up with no major trigger? Sometimes, if you are so predisposed and under some physical or emotional stress in the first place, tiny things can trigger lapses into anxiety or depression. There might be nothing wrong with your life, leading you to beat yourself up for “not having a good reason” to be depressed. My longest and most severe depressive episode occurred when I was studying a course I adored and felt I had found my calling in life, in a happy and stable relationship with a man I loved, had lots of friends and my relationship with my family was better than it had been in a decade. There was nothing external to change. There was nothing internal to change either: I worked so hard to avoid resorting to self destructive behaviours in order to cope. I fought my anxiety, I kept getting out of bed and going to university even though I was exhausted and wanted to die, and I talked to my boyfriend, family, friends and professionals. Regardless of this I ended up in hospital. The bad thing in my life that needed to change was the depression itself, and at the time that was not within my control.

I do feel that the point about feeling stronger for having survived may be true up to a point. I feel proud of myself for getting through all the things I’ve had to deal with in my life, and the techniques I learned during recovery for dealing with my mood and anxiety are invaluable in other areas of my life too. I think they make me more capable of coping with life as a whole, rather than just being useful for diffusing panic attacks. I have also learned a lot about myself, which might help me avoid having a midlife crisis thirty years down the line, but this is only true because I have come out the other side – it was certainly not true when I was still unwell. Further to that, in some ways my experience has lessened my ability to cope, because I am still prone to panicking when I feel very anxious or low. I am terrified of becoming severely depressed again and not being able to make myself better no matter how hard I try, and this means I don’t always cope with stress in the most effective way possible. So basically my experience with depression has made me both better and worse at coping with life, and these effects probably cancel each other out anyway 😉

If I had to summarise my overall reaction to these two articles I would say yes and no to both. Recovery is possible but vigilance may well be necessary during times of stress and illness, and depression affects a person in such complex  and individual ways that it is impossible to make generic statements about any positive aspects. I had to be awkward 😛

Thoughts?

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3 responses to “Pull up a soapbox

  1. The NY Times article is quite thought-provoking, as is your analysis Katie. I think that full recovery from AN is indeed possible for some people, but like you, I think that this depends upon how you see the illness. I have recognised over recent years that what I have/had described as ‘my anorexia’ is not the same as what others describe as their anorexia. I see some people who are weight recovered but describe themselves as anorexic because they hate their bodies, they are still dependent upon calorie counting, or because they are still depressed. Many people I know of describe their anorexia as a desire to be thin and to lose more weight, or maintain a low weight. But anorexia was none of those things for me. For me, anorexia nervosa comprised a set of obsessive behaviours around under-eating and exercise with no intention to lose weight. Yet, the inevitable consequence of restricting and over-exercising was that I entered a state of negative energy balance and lost weight. And whenever I lost weight I was scared of re-gaining it; but not because I worried I’d become ‘fat’ or look ‘fat’, but because I couldn’t control my anxiety.

    I had OCD and other ‘difficulties’ long before I ever developed anorexia nervosa, and those still remain, to some extent. I am prone to anxiety and depression, and I know that these can be triggers for me restricting food. But I also have strategies in place that I use to try to cope with anxiety and depression (and I don’t mean medication). I have to remain vigilant. I think I agree with Daniel LeGrange when he writes: ““If you have another crisis, you’re predisposed to resorting to starvation as your way of managing that issue. It would be foolish of us as clinicians not to prepare our patients that they should be on the lookout for a recurrence.” However, although that applies to me, it doesn’t necessarily apply to everyone who develops anorexia or other EDs. I don’t believe that anorexia nervosa is a homogeneous illness.

    I think that everyone who achieves a state of recovery from a mental illness wherein they are able to manage the illness and prevent relapse deserve a medal. You are right to be proud Katie 🙂

  2. I agree with you that issues like this need to be handled sensitively. I can relate to the “depression as a catalyst for change” thing quite a lot, but it can be dangerous to view this in an overly simplistic way.

    One of my episodes of depression happened when I was in a job that was wrong for me in so many ways. It was making me stressed and miserable, but I couldn’t make sense of those feelings, so I pushed them down and tried to ignore them. I ended up too low and exhausted to work for six weeks. That was a big wakeup call and was when I left my job and became self-employed 🙂 – a classic example of depression doing me a favour.

    However, my most severe episode of depression started when I was in my final year of my first degree. Yes, I was extremely stressed by finals and it pushed me over the age, but it wasn’t really uni that was the problem. I loved my course and had great friends and had been happy. At the time, it really felt like the depression came out of the blue for no reason. Looking back, and with the benefit of therapy, I can see that I pushed myself way too hard and made myself ill, but the things that needed to change were my perfectionism and low self-esteem, not my course or career direction itself.

    When I feel depressed or burned out I do try to think about what, if anything, needs to change. Sometimes there’s an obvious answer, sometimes there isn’t. A third episode was triggered by the stress of moving house, and all that really taught me was that I wasn’t yet well enough to cope with stress. 😉

    I recently read Gwyneth Lewis’ Sunbathing in the Rain, an interesting autobiographical book about what depression can teach us. I found a lot of it helpful, but I do think she overstates her case at times. For example, she says that those of us who get depressed have an advantage over those who don’t, because it’s an “early warning system”. For me it’s more of a late warning system – I am sure a mentally healthy person would have acknowledged their job was not a good match for them far sooner than I did! She suggests people who struggle on without getting depressed will eventually go mad (=psychotic?) instead, but I’m not sure there’s any evidence for this.

  3. Still being immersed in disordered behaviours and depression, it’s difficult for me to make a coherent statement one way or the other about these articles…I wish there was something as insightful as the posters above that I could add but all I can do is thank you for posting your thoughts on such articles because it gets me thinking more deeply about the validity of the research etc. behind such things, rather than blindly accepting the generic statements made as I used to.

    I wasn’t sure whether to ask on FB or here, but if there was anything there that you wouldn’t mind me reading then I was wondering what the PW for the last post was? I hope there isn’t anything wrong!

    Thinking of you

    ~Jess~
    xxx

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