My friend posted a lovely quote on twitter earlier: “At any given moment, you have the power to say “this is not how the story is going to end”” (author unknown, despite ten minutes of googling). I replied: “I love that quote. Although the initial decision isn’t nearly as hard as maintaining the momentum of change!” and she agreed with me.
It’s a quote which has particular relevance in recovery. We are sold the story that we can have anything we want, including health and happiness, if we want it enough. To my mind it is both true and false, empowering and damaging in equal measures. Discovering that you have the power to save your own life is incredible, and many people do manage to recover from life threatening addictions, eating disorders and other mental illnesses. Many people are left with no alternative but to find some way to survive by themselves, as they are repeatedly let down by professionals, insurance companies and so on. But faced with the same lack of support, others struggle throughout their entire lives and die prematurely. I have no idea what marks out one group of people from the other – as far as I can tell from my friends it’s not severity or duration of illness, nor willpower. It’s a hugely complex subject, and one I hope research can eventually tease apart: the factors which combine to make spontaneous recovery possible or impossible. All I know is that some of the bravest, most determined, intelligent and generally wonderful people I know are still very unwell, despite their best efforts – and that others who came exceptionally close to death are now fully recovered. It’s completely bizarre.
So I can’t tell anyone how to recover, or even how I have managed to avoid serious relapse. I can’t relay the exact set of conditions, thoughts and exercises necessary to make a lasting change. I can’t promise that I have achieved a state of lasting change. I’m three years into recovery, and it’s still ridiculously difficult to maintain the progress I’ve made sometimes. If I’m honest, I’ve been hanging onto recovery by my fingertips ever since I moved up to Newcastle, eighteen months ago. It wasn’t the move that did it, it was the FIVE separate stomach viruses in two months I caught during summer 2010, coupled with my emetophobia. That’s what I got for moving in with two junior doctors, who brought a truly impressive collection of viruses home with them. After moving out, during the first half of 2011 I managed to stabilise things and make a little more progress on top of that – only to slip back again when I started work in June. It’s not like I’ve been losing weight consistently or even deliberately, it’s just that I have very gradually, over the last eighteen months, gotten closer to the bottom of my safe range, until now I realise that I’ve been maintaining right on the line for months. The line, this is, that I established in 2009, when I lost my momentum to push through the last few pounds to my target weight. I know in reality I am probably 10lbs under where a healthy 27 year old should be. My periods are regular, my cognitive function much improved even compared to a year ago, and I have no urges to binge, no cravings, no obsession with food. I eat intuitively, and the idea of having fear foods seems laughable considering the amount of chocolate I get through. It’s tempting to argue that this is where my body wants to be, even if it is a bit close to the wire. But those restrictive thoughts and urges will not leave me alone, particularly when I’m under more stress than usual. I can’t work out if this is because I could do with gaining a few more pounds or if it’s just because I’ve been under more stress than I can handle with for the last seven months, trying to cope with the job of doom.
I found working directly on my motivation to change invaluable during the early stages of recovery. I wouldn’t over-simplify things enough to say that this is what made the difference between life and death because that would be silly, but it was a big help to me. I used – as I told my friend earlier – just about every technique in the book, whichever book that might be. I wrote a letter to myself in five years time, first assuming I had not made any steps towards recovery, then imagining myself to be fully recovered. I neatly laid out lists of pros and cons, both of staying unwell and of recovering. I created two posters for my bedroom wall, of the physical, cognitive and emotional consequences of anorexia, and of all the reasons to recover I could think of. I duplicated those reasons to recover on a set of revision cards and carried them around in my bag, taking them out at least twice a day to remind myself why I was doing what I was doing – more on particularly stressful days. I kept myself accountable by being honest on my blog and with my family, to the extent of keeping a weight chart in my kitchen at home in Dorset for everyone to see. I kept problem solving and solution-focused approaches foremost in my mind: whenever I came up against an obstacle I identified what was happening, possible reasons why it was happening, and how I was going to stop it from happening. My aim was to change my default setting: from automatically responding to stress with eating disordered behaviours to automatically responding with healthy coping strategies.
I don’t do half of those things anymore. This is the danger of becoming complacent in recovery. The great thing about all of this is that I seem to have created room for error: in becoming complacent I haven’t relapsed entirely. There have been some dodgy moments and I could probably be doing better, but for three years in I’m still doing pretty damn well. I am at a technically healthy weight, even if I suspect it may be slightly on the low side. I am eating a little erratically, with my intake disproportionately weighted towards the evening (when I suddenly think oh crap, haven’t eaten nearly enough today), but I am consistently making the decision to catch up rather than letting it slide and promising to start eating more tomorrow, which I am well aware would never happen. And I’ve been through enough stress to lead to a full blown relapse in the last few months – yet all I am having to combat is cognitive, rather than behavioural eating disordered symptoms.
My initial motivation for changing back in 2009 was that I suddenly realised no one was going to force me to get better. While that might have felt like a godsend to the younger version of myself, I was twenty four and the illness had comprehensively destroyed my health, education, career prospects, relationships, friendships – everything related to my quality of life. I had this image of myself getting older and older and still living with the illness, repeatedly trying to sort my shit out and always having to defer to relapse and accumulating disability. And right then, living with the illness became more terrifying than the sense of horror I felt when I considered eating more and gaining weight. But even then, I could easily have become overwhelmed by the sheer amount of work I had to do to get anywhere with recovery.
I wish I had answers, both for myself and my friends who are still struggling.
Wishing isn’t going to help anyone at this point. I am facing several problems at the moment, mostly related to work and my mental health, and I think it is probably time that I started focusing on taking care of myself to build up my psychological resilience, so I can cope with more. That involves revisiting some of the principles I established in early recovery: working on my motivation, eating six times a day, not allowing myself to make excuses for undereating and reminding myself of the importance of maintaining a genuinely healthy weight range, not settling for the minimum necessary for health. It’s not a step backwards because everyone in recovery goes through crappy periods when their stress levels are through the roof and bad habits start to sneak in again. It’s tempting to ignore it and imagine that things will get better once those stress levels decrease, but I am reminded of life just before my most serious relapse, back in 2006. I had been at a healthy weight for a few months but had lost sight of the need to work on my recovery directly and instead become complacent. Gradually stranger thoughts, urges and eventually behaviours crept back into my life, until the hospitalisations and digestive problems of 2007 became the catalyst for a major relapse. If I started to experience similar digestive problems now I’m not sure I would be as resilient as I was even last year, in the face of all those stomach viruses. A year or more of being distracted by other stresses has left me vulnerable. I wonder where the Katie who was going to take the world by storm has gone. I can’t seem to put a finger on when she became so tired and ambivalent.
Considering the circumstances, I’m doing well for someone who has been in recovery just shy of three years, living independently for the last eighteen months, with no professional support and no one watching that I keep on eating. It’s not much short of a bloody miracle when I put it like that. But it’s still not good enough, not really. Not in any self-flagellating perfectionist sense; it’s just that if I want to avoid relapse long term, and if I want to find out if full recovery is possible for me, I’m going to have to do better. Not just hang around hoping things don’t get worse.
The initial decision, in February 2009, was terrifying. But I had so much possibility and potential ahead of me, and that kept me going. Now, when the stakes of life and death have receded into the distance and the step by step process of regaining weight and health is long past; when I have to cope with my pre-morbid anxiety and depressive tendencies without the numbing effect of restriction or the hope that weight restoration will completely alleviate them; when I am three years down the line and feel so under pressure to avoid relapsing when I’m approaching thirty and I’ve lost so much time already; when there is no immediate comfort in self destruction and yet so many different stresses associated with functioning as an independent adult – then, recovery is a different matter. I am past the time when any given moment could be a turning point. It’s a long game now, and motivation is more important than ever.