The truce

[self-harm, mention of sexual assault, suicidal thoughts]

I don’t really know why but I grew up hating my body. I hated how it looked and I hated how other people treated me because of how they thought it looked. I read somewhere when I was a young teenager that your body is just there to carry your mind around and that framing stayed with me. I never considered how it felt.

I started self-harming when I was 14 years old. I mostly cut my abdomen with a razor blade. I also cut the tops of my thighs, my inner thighs, my hips, my left shoulder, my chest and my breasts; anywhere that was covered by my PE kit. I think I self-harmed because I didn’t know the words how to express my pain, frustration and anxiety from my untreated depression. I had also been extensively bullied at school for years. I had a lot of suicidal thoughts and plans too.

After eighteen months or so of self-harming, I finally went to my GP, was honest about my symptoms and I was given fluoxetine (Prozac) and weekly counselling (changed days to what people get today) which helped a lot. My GP was very matter of fact about my self-harm and focused on what I now know is called harm minimisation. I never felt even a flicker of shaming. I had been self-harming every day: every night in the bathroom before I had a shower. I always had wounds in various stages of healing. This is actually kind of horrifying me now to look at these memories from my current relationship with my body but it was so normal then. It felt like a logical and sensible response to my life. It fucking was a logical and sensible response to my life. But the self-harm just melted away as the depression melted away. I don’t remember any kind of fight to stop. It just naturally camed to an end. From the time I was 17 years old to now in my early forties, I have self-harmed less than a dozen times. When my mood is bad, thoughts of self-harm do come into my head but they feel miles away. It’s only in the worst of situations that I actually do go past thoughts and act on my body.

Can you only self-harm if you hate your body first? I don’t think that’s true. Sometimes things are just very desperate. There are no good choices available in some situations. But I did hate my body; almost as much as I hated myself. Those hatreds and despairs felt separate from very early on and remained separate until this year. Note that I’m not saying the hatred and despair has melted away but it feels like a frayed, stretched apart cloth between me and my body rather than a solid, impenetrable wall.

When I look down at my hands, there is still a tiny pause while I recognise them as mine. They don’t feel like mine but intellectually I know they must be. There is a much bigger pause when I look at body parts that I dislike more like my abdomen or my breasts (it still feels weird typing “my” there; my habit is to say “the abdomen” or “the breasts”).

That pause and the detachment were put there deliberately to protect my body from me. I can’t remember exactly what I read or what I heard that made me decide to pursue this detachment but I remember pushing it in my mind until feeling like I was quite separate from my body was a very natural state. It tied in well with my depersonalisation.

The next stage was a calling of a sort of truce between my body and myself. I think this happened in my early twenties. I had been sexually assaulted a few times by then though had convinced myself that it wasn’t affecting me. I was dealing with a lot of psychiatric medication side-effects. I was fat and finding that unacceptable to myself. My body didn’t feel like mine and I still hated it. I was reading about fat acceptance and I longed for the peace that the people I was reading about had found. It wasn’t this but I read something like this tweet from Michelle Allison (the Fat Nutritionist):

Your body is not an object, not a sculpture based on some universal and enduring Platonic ideal of beauty — it is a living creature, an animal in your care that needs care and compassion, that suffers and dies if neglected. https://t.co/Q1lTdtI1or— Michelle Allison (@fatnutritionist) December 20, 2017

It lead to a sort of ‘truce’ or ‘deal’ in my head: I won’t hurt you anymore and you will leave me alone. That was the basis of my relationship with my body for the great majority of my adult life. I did the basics to look after it, to some extent anyway, and the rest of the time I was free to ignore it. The best that can be said for this ‘truce’ or ‘deal’ is that it eased my relentless drive to kill myself which had been powered by my hatred of my body. The thoughts were still there but there was a distance too. I self-harmed very rarely. I gave up drinking alcohol entirely and I didn’t take drugs (I was very lucky in that I hadn’t developed addictions to either). I didn’t exercise and didn’t eat very nutritiously but I don’t think I had any disordered eating behaviours either. But it was a miserable, joyless way to live, I see now. Not taking any pleasure in my body, whether that was eating or sex or physical activity, etc, meant missing out on a lot of the experiences that make life worth living and make a human, human.

What changed was I read two books this year that profoundly challenged my thinking. The first was Come As You Are by Emily Nagoski about female sexuality which explained a lot of my past experiences to me, not just about sex but also about emotions and the stress responses. The second was Intuitive Eating by Evelyn Tribole and Elyse Resch which explained a lot about eating, hunger and fullness. Both of these books talked matter of factly about taking pleasure in your body and of being connected to your body. It probably sounds ridiculous but I’d never considered that was possible. I kind of knew that some people had strong, solid relationships with their bodies but I didn’t think that applied to any of the people in my life and certainly not to me. But these books were arguing that yes, it was possible for me too.

So I stepped inside my body. Quite terrifying at times and very unsettling. These books made my thoughts safe enough and the meditation released my depersonalisation enough to make it possible. My medication and all the endless self-care I do controls my mood enough, at the moment at least. I still feel some detachment but I think that is fading as my new thoughts bed in. In some ways, I am convinced being connected to my body is a much better way to run things rather than my old detachment and ‘truce’ but in other ways, it feels riskier and more unstable.

I’m still afraid of my body and I still don’t like parts of it but the old hatred and despair has faded away mostly to nothing. I’ve seen it flare up a bit at times but not for long. Is this a new truce? Not really. This is very soppy but I feel like my body and me might be on the same side now. There is something very peaceful and lovely with that.

Sometimes they are the storm

This will make no sense because I am currently high. Best of luck.

Some people you like to have in your life because you feel like you are walking down the same path through the world, through life. It’s companionship and warmth and while it might not give happiness all the time, it does give comfort. People underestimate comfort.

Some people you like to have in your life because you can stand in their lee. The world or life rains down against them and you stand in the shelter, for a while. Time to breathe, maybe some solace too when times are tough.

Some people you like to have in your life because the path is boring and even the storm above you is not enough and you want to be engulfed and let yourself be the very rage and despair. They are the storm itself.

Self-esteem meditation

I started meditating in June using the Headspace app on my phone. I signed up and did the free meditations for the first few (four? ten?) days and then bought a subscription.

Meditating has made an astonishing difference to my depersonalization. It is literally the only technique that has made a significant difference though, to be fair, I have felt so hopeless about finding anything that helped that I don’t think I made a serious and sustained attempt at any technique. This wee app made a difference right from the early days. Never in a way that was too much of a shocking, painful change (snapping into hyper-reality from being very dissociated is profoundly fucking terrifying) but a feeling of control like if I push that particular part of my mind that the app targets and calls mindfulness, that particular part of my awareness, then the depersonalization recedes back. If I lift off that particular part of my mind then the depersonalization will drift back in. It might sound mind-boggling for it to be important to me that I can get the depersonalization back if I want it but it is important as it has helped me get through things that I don’t think I could have survived another way. Well, maybe. Maybe not. It’s mine though and I want to be able to send it away and call it back as I chose. That might not be possible and might require far too high a price but it’s what I want just now. The depersonalization is not my master these days, well, not all the time, and I am grateful to the meditation for that.

The Headspace app has has a huge library of meditations on topics from grief to sleep to productivity. There is a thirty episode course on self-esteem. Here is the introduction to episode 4 of the first ‘Learn’ ten episodes:

Now after a lifetime of thinking that we are not good enough: maybe we don’t like the way we look or the way we are or the way we feel or the way we think. Maybe we don’t like the way we think other people think we are. Low self-esteem can affect us in so many different ways. But it’s always looking for more fuel because all of these internal storylines that we have, it doesn’t matter if it’s low self-esteem or something else, they all require fuel and that fuel is thinking. So it’s quite normal when we come to an exercise, to learning something new, that we fuel it with whatever is most common in the mind. So for someone who gets very anxious when they’re learning a new exercise like this they might be very anxious about the exercise. Someone with low self-esteem learning a new exercise will probably think that they’re no good at it or that they wish that they could do it better or they wish that things were changing faster. And that’s just the nature of that storyline playing out. Again we don’t need to give it more attention and more credence than it deserves. It’s simply recognising that’s the habitual pattern of thought that has built up over time. It’s not who we are. The less we identify with it the less important, believable almost, it becomes in our life. So just something to bear in mind as you’re doing this each day. Coming to the exercise completely fresh, leaving behind any preconceived ideas as to whether you are good at it or bad at it, whether it’s going to work quickly or not. Simply watching the process. Being present with it as it unfolds.
Introduction to a Headspace self-esteem meditation episode 4

I think that is a fascinating way to think about self-esteem. I was expecting some nonsense about self-compassion (which isn’t nonsense; I just can’t get it to work for me) being the better way to consider or judge the self. But this idea of thinking just being fuel in an unwanted fire undercuts this and made me pause and really look at my assumptions. I don’t fully understand it yet but I will keep thinking about it and finish the course. Things that I thought were self-evident, obvious, solid premises might actually not be true or even just actually not that useful. It’s so lovely to come across something new that gives me some hope that things might be different. Of course, I am a psychiatric patient of twenty-five years standing so I know that hope is heady stuff except heads aren’t often involved (to paraphrase Terry Pratchett) and I’m not going to call myself cured quite just yet. Put a button in front of me and say “press this and you’ll never have existed” and the only delay to me pressing it is my formerly middle class upbringing that will make me pause to say “thank you”. I’m almost entirely convinced that I don’t deserve good self-esteem. That things are bad because that is they way they should be. I really don’t know what makes me keep trying things like meditation. It’s certainly not logical. Well, that tangent went a bit dark. Aren’t you glad you are wasting your life reading this blog?

It’s just so fluffy… meditation, mindfulness. How can you take such simple concepts seriously? Dissociation is so huge and complex. Abnormal mood is so huge and complex. How can something as beyond basic as focusing on your breath help such severe, profound, overwhelming symptoms? A huge and complex problem needs a huge and complex solution, right? Turns out that that assumption has done me a lot of harm over the years. Here’s an analogy: you spend six hours making a hugely complex and fantastic meal. It should have a rich interplay of exquisite tastes and textures. But it’s just bland and flat and sits in the mouth like stale bread. Less interesting than stale bread, even. You’re fucked, right? Nothing simple is going to save this meal, all this work, you’re going to have to start again. Wrong. Turns out the very simple addition of half a teaspoon of salt brings these flavours to life. Sometimes something simple is all that is needed. I’ll add to that though: sometimes a series of simple things is all that is needed.

The other reason I resisted mindfulness and meditation is that is so goddamn fashionable and pushed on us psychiatric patients. Another simple concept: what works for one person’s problem might or might not work for another person’s apparently similar problem. Don’t we get to chose where to spend our (very limited) energies? I came to meditation of my own volition. I kind of fell into it naturally, first through a real life friend and then by enjoying how well written the app was and then by being astonished by the results. It has just happened. Just happened because of lots of little choices that I made. So it feels like it is mine. I told my current psychiatrist recently that I had started meditating and he said “good on you” but didn’t push. I felt pleased. Going by twitter, a lot of people have bad experiences of psychiatric services almost insisting that they spend chunks of their time and using up chunks of their energy on techniques that were, at best, useless and, at worst, actively harmful. So that put me off too.

This feeling of being able to make choices and make good things happen in my life is valuable and precious to me. Not quite as much as the relief in my symptoms but it has been an unexpected bonus. That’s unexpectedly boosted my self-esteem as well. I can do something! I’m not 100% hopeless! (Just 95% replies my brain.) Did the people who wrote the app mean for that to happen? Who knows, but it’s good anyway.

Massage and the need to be touched

I remember as a child, maybe late primary school and early secondary school ages, having this desperate wanting to be hugged. Like something was physically missing from my body. It never even occurred to me to ask anyone in my life to hug me. My parents weren’t physically demonstrative and neither was anyone else so I just wasn’t touched for years until I started having romantic relationships.

I’ve had “low maternal warmth” written on my psychology notes now (see how they blame the mothers; not the fathers) and I’ve learnt how most (almost all?) people need a certain amount of physical touch and physical affection in their lives. The two times I’ve had long term romantic partners have been the times that I’ve had consistent touch and probably the main reason why I (mostly) remember those times fondly. I’ve not had a partner for a long time and that’s what I miss the most by far. But even just briefly imagining it there, I get strong thoughts that I don’t deserve it and that that will never happen again for me. Probably fair to say that I am too fucked up psychologically to be inflicted on another person. Anyway, the touch I am describing here is very different from sexual touch. I think it’s possible to meet all my needs for physical touch without any kind of sex.

I am a child of the MDMA (ecstasy) days, before ‘legal highs’/novel psychoactive substances, and one of the effects of that drug is that my friends and I got into the habit of hugging a lot. I remember that time fondly too. I still hug my friends to say goodbye and most of my family too. But these are quick hugs that don’t soothe my brain the way a long hug does. When my relatives’ children were small, I would hug them a lot. Partly because of my absolute fucking horror at the thought of them feeling like I did when I was a child and partly because it made me happy. I’ve had two long hugs in recent months. One from one of my oldest university friends and one from my sister and both because I was upset. They helped, and I am grateful for them, but they weren’t enough. I feel like I am this empty, insatiable pit of need when it comes to wanting to be touched.

So if you read the self-help articles and books then you are advised to try ‘therapeutic touch’ when you feel you don’t have enough touch in your life. I was given a voucher for a massage as a birthday present and I’ve had two and going to have a third today. They are very expensive. It feels intensely relaxing physically and my muscles feel liquid and released. But it’s for the psychological benefits that I am doing it. When my massage therapist moves round the couch to a different area she keeps a hand on my back or my shoulder. I am sure there is some what I’d disparagingly call hippy or spiritual (because it’s outside of my knowledge and experience) reason for this but what actually happens in my brain is that it suddenly starts thinking “I am normal” because she hasn’t taken her hands off me the second that she could. My brain starts thinking I might be okay and not entirely repulsive and repellent. Just a normal human body. A bit of detangling of my thoughts.

I grates with me that I have to pay someone to touch me and can’t find it naturally in my life. But, as previously mentioned, I am not in a position to have a romantic relationship and that seems to be the way that my society is organised to meet people’s needs for touch. I am lucky that I have this massage therapist that I feel safe with, and can occasionally afford to pay, and that I have my friends and family to hug. Maybe one day I will have more, and I would like that, but it’s okay just now.

Disregard

I wake up and I am full of joy. Nothing has happened to justify it or explain it and my mother has just died so it’s probably not a genuine feeling. It’s just nonsense generated by my broken brain. So I push it away and I disregard it. I ignore this feeling of joy and try to not let it colour everything else in my mind. I’ll probably fail.

I walk to the park to run and my head is full of relentless negative thoughts. I can entirely understand why people used to, and some still do, talk about mad people being possessed by demons. These thoughts are so strong and overwhelming that they overwrite everything else. But they are just more nonsense generated by my broken brain. I disregard them. Try to remember the psychotherapy: how to dismiss thoughts without engaging with them; let them come as go like trains in a train station but don’t get on board.

I sit on my sofa staring at the wasps battering against the inside of the window. I know I’m stressed and when I’m stressed then my broken brain sometimes generates pictures, sounds, tastes, smells and sensations that aren’t based in the reality that other people have. So I tell myself that the wasps aren’t real, that they will go soon. Disregard. Ignore the feelings of panic that come with these pictures and ignore the thoughts of “sometimes they are actually real and these look really fucking real this time”. Disregard, disregard, disregard.

If so many of my feelings and so many of my thoughts and so many of my perceptions of the world are false, just generated by my illness, then what exactly is left that is me? How can I tell what is me now? Before my illness got so severe, this never really occurred to me. I just accepted that I had all my normal, genuine experiences and then these extra experiences of illness on top. I didn’t feel like I was missing out and I think I thought I was getting more than my fair share of experiences. But now, I spend so much time sorting through this junk. It’s a constant untangling and straightening out. A constant observation, assessment and interjection of (my attempt at) reasoning.

It reminds me of being a little girl coming in from playing outside in wind and my mother detangling my long hair. It hurts and takes so long. Should have worn a hat.

Sometimes I have genuine feelings, thoughts or experiences, whatever genuine or real means, that I initially automatically dump in the category of ‘illness’. I saw a vivid and splendid sunset on holiday and my first thought was “oh no, I didn’t realise I was getting high but these colours are just too beautiful to be real…” until other people starting commenting that they saw the same. How many real experiences am I disregarding and dismissing as nonsense generated by my broken brain? And how much nonsense am I accepting as true that is actually not? This dichotomy of real/unreal, genuine/fake and well/ill isn’t clear cut even if I could reliably tell the difference. This morning I woke up with a feeling of dread which I think it partly due to my low mood but is also partly due to the fact that I am going to have to talk about something very painful today. It’s both.

I disregard so much and maybe that way of thinking, of organising my thoughts about my life, is adaptive and functional most of the time but it certainly doesn’t make me happy. Maybe a broken brain with so much junk and nonsense can’t generate happiness; it’s too busy generating dread and wasps. Maybe that thought is self-pitying nonsense generated… Disregard, disregard, disregard.

This to me is one of the core differences between mad people and non-mad people. We have had to question and doubt things intrinsic to our very selves that non-mad people have the luxury of just assuming are real and genuine. I think it changes us. It’s definitely painful a lot of the time. Frustrating too. Am I supposed to now say that this greater awareness is all worth it? No fucking way, the pain from all these feelings, thoughts and hallucinations is definitely real even if their source is not.

Routine is king

I did a NHS psychoeducation course about bipolar disorder a few years ago. It was surprisingly informative. I thought I was pretty well read already but I learnt some useful things. I also met some people who I am good friends with now.

A lot of the information about bipolar disorder was relatively basic and would not have been out of place on a standard educational website for people newly diagnosed. The interesting bits were two metaphors that they used to ilustrate this information.

The first was the concept of a stress bucket. Everyone has a unique capacity for stress (the size of the bucket) and has different stressors in their life (fluid filling the bucket) and different stress relieving techiniques (a tap or holes emptying the bucket at the bottom). How much stress you can take before you develop symptoms (the bucket overflowing) is mostly genetically determined, so the theory goes. To stop the bucket overflowing, some people need to work harder than others to bring their stress levels down and to reduce the amount of stress coming into their life. I think I liked this metaphor so much as it made me think that I wasn’t to blame for how little stress it takes to destabilise me. I just have a small bucket in my head. Also, it made sense to me to link reducing incoming stress to increasing stress relieving activities. I can adapt to having a small bucket filling up quickly by putting in lots of taps.

Secondly, the psychoeducation course used the metaphor of a mood thermostat. Just like the thermostat for your central heating, a ‘normal’ brain tries to keep your mood within a certain range from sad at the bottom to happy at the top. It has mechanisms to lift up your mood (such as drives to do things that bring you pleasure or make you happy like seeking social contact, eating, sex, etc) and mechanisms to dampen down your mood (such as making you feel tired so you sleep or rest). A bipolar brain isn’t very good at keeping your mood in this normal range and veers up from happy to mania and crashes down from sad to depression. The psychoeducation course talked a fair bit about things that we could do to help regulate this mood thermostat. These days, this is called self-care. The strategies that I use are eating regularly and nutritiously, getting enough but not too much sleep (it took me years to fully apply sleep hygiene but it has worked very well for me), exercising, taking medication as prescribed and avoiding alcohol (nine years) and recreational drugs (sixteen years, yes, I am bragging now). I don’t think there is any actual clinical evidence for the recommendation to try and have routine for your daily activies but it seems to be common advice from healthcare professionals. The psychoeducation course’s wording was “routine is king” which has stuck with me because it’s such an odd way of putting it.

My central heating thermostat dial with a post-it note with a blue unhappy face on the left and a post-it note with a red happy face on the right.

For many years in my twenties and the first half of my thirties, I had no routine at all. I got up when I couldn’t make myself sleep anymore (I would have preferred to have been dead but sleeping as much as possible was close as I could get) which could be any time of day. I went to bed when it finally occurred to me and that could be anytime from 9pm to 7am. I didn’t eat at particular times. I didn’t exercise at all. I certainly wasn’t taking my medication regularly and several times got scunnered of it and stopped it all entirely. The only thing I was doing ‘right’ was that I wasn’t drinking or taking recreational drugs.

Now, I have somewhat swung the other way and have a very scheduled routine. I get up at 5am and go to the gym or for a run at 7:30am except for one, or sometimes two, rest day a week when I sleep in and get up around 9am (that is a very much against sleep hygiene but hasn’t, so far, disrupted my sleep). I have breakfast when I get up and a snack/second breakfast when I get home around 10am. I eat lunch around 1:30pm and dinner around 6pm and have snacks in between. In the afternoon, I try to get out the house and see a friend or at least walk around other people. I am an extrovert and I get lonely if I don’t talk to other people for more than a couple of days. Something happens in my brain and I get this numb, stretched feeling like everything is wrong. Took me a long time to connect that feeling to not having social contact. Phone calls help so sometimes I phone family instead. I try and read a book and play the guitar every evening. It doesn’t sound like much when it’s written down. I imagine the ‘normal’ people are wondering what I do all day. Manage fucking symptoms, of course. But that’s another post.

I have definitely taken the advice of getting and maintaining a routine to heart. I think it has improved my quality of life but maybe things would have improved anyway. The disadvantage is that I have become a bit rigid in when I am comfortable doing things during the day. I feel unsettled when I can’t eat or go for a run at my usual times. If my mood is already bad then I don’t just feel unsettled and uncomfortable, the change can totally derail me and my entire routine breaks down for a few days or sometimes longer. Now that I am using intuitive eating, I hope that I will learn some flexibility with my eating at least as you eat when you are hungry and not according to the clock. I have been more flexible with my exercise routine over the last few months too.

So routine might be king in my life now but it wasn’t always. On the whole, things have improved but it is not the silver bullet that some people have suggested.

Why can’t I stop

[eating disorder, calorie numbers, suicide]

I binged on Tuesday. I don’t know how badly as I didn’t count it up but would guess around 2000 calories, maybe more, on top of a normal day’s intake. It was nearly three weeks since I had last binged, which was when I had properly started intuitive eating, and the ‘clean streak’ of no binging had become magnified in importance in my mind. I feel bitterly disappointed in myself and despise myself for ruining everything… hang on, hang on, getting a bit carried away there…

As is my pattern, I had been saying to other people that things seemed to be going well in the days before it all went to shit. I had been trying to introduce one of my online friends to intuitive eating by talking about how it had stopped me binging and allowed me to become much calmer around food. Now I have pretty much ghosted that group though I do plan to return. It makes me feel so stupid that I could have convinced myself that I was doing better when obviously I was just kidding myself. I feel pathetic and like I am always going to be stuck in this pattern. However, I suppose it is possible that going from binging regularly to not binging at all was an unrealistic goal and that simply binging less is still progress. I could scream in frustration right now because I don’t know what is going on or what anything means. I don’t know what to do for the best.

I had been having a couple of ‘hungry days’ where I seemed to be getting hungry more often than I felt comfortable with or thought was reasonable. For example, having a substantial snack at 10am then hungry for lunch at 12pm then hungry again at 1:30pm. It fucked with my head with all the “am I really hungry?”, “this is too much food”, “my clothes are tight”, “my abdomen is much bigger”, “I’m not doing this right” and just an overwhelming torrent of critical and doubting thoughts. I had a lot of diet mentality thoughts that I was eating an unacceptably large amount of food and was gaining an unacceptably large amount of weight. I didn’t weigh myself but I measured my waist and it’s gone up from 30.5″ at my lowest weight to 32.5″ now which is above the cardiovascular risk cutoff. I had packed away my size 10 underwear as it was too tight and a pair of fitted trousers are now too tight as well. I just felt unacceptable and abnormal and hyperaware of this deformed, ugly body that I want to be rid of. I spent two years managing my anxiety about my body by saying “it’ll be better soon, you’re losing weight, it’ll be better soon” and dealing with the feelings of being suddenly huge by remembering that my weight that morning was pretty much the same as yesterday’s and the day before. Now I am adrift. I have never developed any other coping techniques.

The binge sneaked up on me. I had gone to the gym in the morning so was even hungrier than usual but had had breakfast, a morning snack and lunch. By mid-afternoon, I was suddenly very hungry so had a substantial snack that the dieting mentality thoughts said was far too high calorie. I finished it and sat at the table with my head in my hands and my thoughts spiralled out of control from “you can’t possibly still be hungry” to “you are going to regain all the weight” to “you should be dead” to “you’re pathetic, you might as well binge”. I meant it too. I really would rather die than go back to how I was treated as a fat person and have all that self-hatred too. Of course, I have plenty of self-hatred now so maybe I won’t notice a difference. I wrote in my diary, “I just want peace and quietness and to feel free”.

At first with the binge, it was very pleasurable. I ate sweet foods that I liked and I ate them slowly and mindfully. I don’t have much pleasure in my life so this was nice. There was comfort. It’s also exhilarating to just go with the out of control, falling feelings.

Then the feelings changed and I started getting this strong push to eat more and more to punish myself. I had images in my mind of me lying in my bed and another me standing over myself hitting me with a thick stick. I’ve had images like that before. The Intuitive Eating book talks about how emotional eating is a spectrum from sensory gratification to comfort to distraction to sedation to punishment. I think I went right along the spectrum. My most common reason for binging is for the sedation as it quietens and slows down my thoughts. It actually works very well for that, for me. There is also a massive relief in being so full that even the thought of food is impossible. It feels very safe like I am finally complete and don’t have to want anything anymore. The self-punishment aspect is less common with me though when I first developed binge eating disorder it was a frequent reason to binge.

I have not reacted well to the binge. I have been taught that practicing self-compassion and being kind to yourself rather than reacting with harsh, self-critical guilt is more likely to allow you to change your behaviour. But I can’t get over my feeling that this is just lying to myself and letting myself off the hook. It feels right to punish myself. It feels like I am doing the right thing. However, it’s not helped me bounce back, that’s for sure. I haven’t exercised, I’ve cancelled seeing friends and I’ve basically shut down. I have spent so much time thinking how much I despise myself and how I am going to kill myself. The latter brings me some comfort. It seems the better my mood is when I binge, the worse the fall is. When I first developed binge eating disorder, my mood was so bad that I barely noticed the guilt after a binge. It’s devastating now.

That has listed out all the negativity in my head. Now to take some swings at it.

Overwhelming rush of shame

[brief mention of suicidal thoughts]

I think almost everyone hates thinking about shame. And really hates talking about shame. It’s shaming to a lot of people to even admit that they feel shame. That didn’t even make sense to me until I suddenly recognised it in myself reading Brené Brown’s I Thought It Was Just Me (But It Isn’t). I didn’t realise I felt so much shame until a few years ago when people began talking about it openly online. I certainly didn’t feel it as a distinguishable emotion. I don’t think I’ve ever been asked about shame by a healthcare professional. Which is a shame because it the driving force behind a lot of my mental illness.

In that book, Brown defines shame as “the intensely painful feeling or experience of believing we are flawed and therefore unworthy of acceptance and belonging”. Yesterday, I was reading and came across a reference to Maslow’s hierarchy of needs. I thought I would just quickly look it up and check that I still knew it. I am meeting my basic needs of water, food, shelter, rest and safety. I am partially meeting my need to feel like I belong and for connection. Sometimes better than others. I am not meeting my esteem needs at all. I don’t feel like I have achieved or accomplished anything with my life and since I am now in my early forties that is intensely shaming to me. I should have done better; everyone else has. I can feel this tension in the back of my mouth and throat, my chest feels tight and I just want to hide in the dark and never let anyone see or think of me ever again. That’s shame.

W ikipedia‘s image of Maslow’s hierarchy of needs

That this is so intensely shaming to me is a problem because it is paralysing me. I am stuck and can’t make plans or move forward. I am too afraid and too angry with myself and too full of disappointment and disgust. It makes me hate myself that I had so many chances and I ruined them all. I hate meeting new people or catching up with people after a long time because I have nothing to show for myself. A big part of my problem is that I don’t have a job and I personally, and increasingly society too, put a large proportion of your worth as a person on your job. I have been on benefits for exactly ten years this month. I have never had a proper career and only crappy jobs many years ago. I had a good school education and did well and then got into a good university to do a vocational subject where I did very well for two years before I became incapable of managing my illness and had to drop out after starting final year three times. Those first couple of years at university are the last time I felt good about myself in terms of jobs or careers and that was twenty years ago.

I know I have low self-esteem but I think my assessment of myself is actually quite correct. I don’t have anything to be proud of so it is logical that I have low self-esteem. Brown says that “[s]hame and self-esteem are very different issues. We feel shame. We think self-esteem. Our self-esteem is based on how we see ourselves – our strengths and limitations – over time. It is how and what we think of ourselves. Shame is an emotion, It is how we feel when we have certain experiences. When we are in shame, we don’t see the big picture; we don’t accurately think about our strengths and limitations. We just feel alone, exposed and deeply flawed” and that makes perfect sense to me.

I don’t really have any drive to improve myself. I have had problems with motivation for many years. I don’t want to feel this shame but I also have this strong feeling that I deserve it and that it is right that I feel bad. The world is as it should be when I feel bad. Yesterday, when I had this rush of shame after thinking about how I’ve not achieved anything, the shame was followed by intense suicidal thoughts of how I had no option but to kill myself. There is no chance or hope at all that I will achieve anything so why continue like this. I will never do better, I’ll only get worse… etc, etc. It was very painful.

Going back to Maslow’s hierarchy of needs, I need to remember how lucky I am that I can meet my basic needs. I was homeless for six months once (not on the streets but in a spare room and unable to find a place of my own) and so having a housing association flat with a secure tenacy is something I hold close and treasure. I’ve been in this house for a few years but I still love locking the front door and knowing that I am safe. I am lucky to receive benefits and get support group ESA, DLA (not been migrated over to PIP yet; there’s a terror to come) and housing benefit which allows me a good standard of living as long as I am careful. I don’t deserve any of this though. I didn’t earn it. It was just given to me. Those thoughts feel shaming too though I can also hear the counter argument that everyone deserves a basic standard of living just by virtue of being a human.

Brown says the way to heal shame is a combination of compassion, courage (she means every day “ordinary courage” not stand-in-front-of-bullets courage) and connection (with other people). I am trying to do a little of those here and then maybe I can release some of my shame.

Two squares of chocolate

[eating disorder, food, calories numbers]

I have been throwing myself into intuitive eating for a fortnight now. In some ways, I am astonished with my progress as I haven’t binged and binging feels very far away. In other ways, I am frustrated that I am still getting all those disordered and painful thoughts.

For around a week before I really committed to intuitive eating, I tried some of the techniques of mindful eating (the book calls it ‘conscious eating’ in places as it predates the rise of the term ‘mindfulness’) but was still calorie counting, weighing and measuring all my food and weighing myself every day as I had done every day for nearly two years. My eating definitely improved with the mindful eating as my binge urges were easier to cope with but they were still frequent and insistent. Even looking back from a fortnight, I am amazed that I coped with how bad those binge urges were. It was pretty fucking horrendous at times and felt really desperate. No wonder I binged and binged so badly sometimes. I had a 4500 calorie binge on Monday 27th May and that was my last totally out of control binge. When I say 4500 calories, I mean that I added it up from the packets so it’s not a haphazard guess. I have had bigger binges in the past but I still find that number pretty shocking. I had a further, smaller binge of 1500 on Thursday 30th May which was triggered by seeing that I overeaten according to my calorie counting app during the day and then thinking “fuck it, I’ve ruined everything anyway”. This is a cognitive distortion called dichotomous thinking and also known as ‘black and white thinking’ or ‘all or nothing thinking’. I felt less out of control during this last binge but it was still a binge.

Now I am continuing the mindful eating, as much as I can while trying to be realistic and not fall into rigid perfectionism, and have stopped my dieting behaviours. I haven’t weighed myself since Monday 27th May and the only food I have measured has been while following recipes other than rice which I don’t know how else to cook a reasonable amount. I have sometimes been calorie counting roughly in my head. It seems to be a way to soothe and reassure myself that I am not eating ‘too much’ but it often backfires and I get anxious about the number I come up with. I spent two years determining how much food to eat based on a glorified calculator on my phone. I picked up rules and advice and recommendations some of which, maybe all of it, is bound to be bullshit and applied them to how many and what kind of calories my body received in a meal or a snack. No flexibility. Nutrition is so incredibly complex and I thought I could work it out in a few minutes on free app on my phone. Instead, now I am using my inbuilt system of analysing how many and what kind of calories my body needs. These internal hunger and satiety cues will supposedly meet all my body’s nutrtional needs and do it in real time too. I am still not 100% convinced that it will work on me as I am worried that I have broken my internal cues beyond repair by dieting. But I know that this last diet, while successful in the conventional sense in that I lost over 100lbs, also gave me binge eating disorder again, hammered my mood and took up swathes of my time and energy. It couldn’t continue as it was.

My major obstacle to trying intuitive eating is my fear of gaining my weight back. I was treated like shit when I was a fat person and my life is a lot easier now. It is partly aesthetics too but I actually look worse undressed as I am on the bad end of the spectrum for how much loose skin I have been left with. I just feel much more acceptable and therefore safer in an average sized body. So I am afraid of gaining weight and going back.

Two of the principles of intuitive eating are giving yourself unconditional permission to eat and to eat when you are hungry. Because I have dieting for so long, I have intense feelings of deprivation and don’t feel secure at all that my need for food is going to be met. I feel like I am just going to force myself to go hungry. I am lucky in that I still feel hunger despite my dieting, though I don’t feel it with much subtly, and I am trying to eat whenever I am hungry and what sounds the most appealing and gives me the most satisfaction (another principle). It is common for people to have a healing process at the start of trying intuitive eating where they eat a lot of ‘junk’ or ‘treat’ foods (which the authors call play foods) as a rebound to the deprivation of dieting. The foods you weren’t allowed are the ones that look the most appealing now you can have anything. They say that if you eat them when you are hungry, really savour them and stop when you are satisfied then those foods will lose their power and hold over you and you will eventually genuinely only want them occasionally. Ha, I thought, bet that’s rubbish and just another mind trick to make you eat less calories with less effort. Ha, I have found out that it’s actually true.

Like a lot of dieters, once I opened a packet of something not usually allowed, like a bar of chocolate, I feel compelled to finish it. It’s because I didn’t know when I was going to be allowed it again so I felt like I had to make the most of this current laxity. Never could manage “just one biscuit” or “just one square of chocolate”. One slip of the rules and it was often a full binge. But I currently have four opened and partially eaten bars of chocolate, and two unopened bars, in my cupboard. I have a craving for a particular type of chocolate and I go and buy it. Some wait in the cupboard as they then don’t appeal anymore. After dinner, when I want something sweet like I almost always do, I put one or two squares on a plate and eat them at the table as mindfully as I can. Somehow, and it feels like magic, something feels soothed and completed and when I think “I could have more now” then I think “nah, maybe later” or just not really bothered. It’s very strange. The fact that I know the chocolate is there and I know that I can go and get it whenever the hell I want makes me seriously consider if I really want it. I am not even sure anymore if I actually like milk chocolate. It doesn’t taste that special. If I had read this a month ago I would have thought that the writer was just lying to themselves in an effort to eat less but it seems this isn’t a mind trick as I thought but just the way (most?) human brains work.

Four opened and two unopened bars of chocolate from my cupboard which even a few weeks ago I would have binged on but now forget about because they are not appealing anymore.

I am trying to reassure myself that the other intuitive eating techniques will work as well the ones as I have used with the chocolate. If that bit works then maybe the advice that I won’t gain much weight if I thoroughly follow my hunger and satiety cues will also work. It’s a leap of faith and I think I am finally ready to take the risk.

Treatment burden and food poisoning

The treatment burden of a condition is the work required by the patient in managing that condition. For my bipolar disorder that would be taking medication, arranging and going to appointments, participating in psychotherapy (including homework) and following the relevant lifestyle advice.

Doesn’t sound too onerous? Take the first one: taking medication. The side effects of psychiatric medication can be fucking grim and well up there in severity with the impact of actual symptoms. For example, sedation is major problem with antipsychotics for me. I am sure now, looking back, that a significant cause of me having to drop out of university was down to the sedation and not being able to get up in the morning caused by my antipsychotic. But I didn’t realise at the time and just thought I was being pathetic and not trying hard enough… I didn’t advocate for myself with my then psychiatrist (who I think would have been very receptive to my complaints) and that is a huge regret of mine. How seriously your side effects are taken is in large part down to the attitude and knowledge of your psychiatrist. Hit and miss, in other words.

The more severe your illness, the more likely you are to be taking multiple medications including more medications to control severe side effects which then have their own side effects. For example, I take lithium. But I also have to take thyroxine because lithium permanently damaged my thyroid and gave me hypothyroidism. So now I have to take another medication for the rest of my life and deal with blood tests and results and making sure I am on the right dose which is harder than it sounds and can be very frustrating. There are a lot of drugs you can’t take with lithium and I have to remember to be careful and check. I have been prescribed a drug that shouldn’t be taken with lithium and it was my pharmacist that picked up the interaction.

(I am in danger of sounding anti-psychiatry with the medication bashing. I am not anti-psychiatry. I think psychiatry is a mix of ‘art’ and science but then so are all specialities of medicine. Many specialities use very powerful drugs that they don’t fully understand how they work and have serious side effects. Many of those prescribing doctors don’t fully account for what they ask for from their patients. These are not problems specific to psychiatry.)

Following lifestyle advice must be simple though, right? Is it hell. For a start, healthcare professionals are not only inconsistent with the advice they give but also contradict each other. There is not the evidence for lifestyle changes that there is for medication and psychological treatments so no wonder there is conflicting advice. What advice you are offered will depend on the individual healthcare professionals’ opinions and preferences. Take sleep hygiene. A short list of common sense recommendations, right? When you have a severe mental illness, those simple changes are overwhelming. The idea of stopping naps to hopefully, but with no certainty, improve nighttime sleep is just impossible when those naps are your only respite from the long, horrible hours and just making it through the day. Nowadays, I follow the sleep hygiene rules pretty closely and consistently and I sleep very well. It has made a huge difference. But it took years. It also means I can’t do a lot of things other adults can do like spontaneous change routines, e.g. traveling. It feels limiting at times and like I am missing out on things.

I got food poisoning last week. I seem to be quite susceptible to food poisoning despite obsessive food hygiene and cleanliness. I don’t get colds or other infections often at all. I am on omeprazole to control the heartburn I get as a side effect from my psychiatric medication. Because omeprazole decreases the amount of acid in your stomach, it theoretically increases your risk of food poisoning as less bugs are getting killed in your stomach. It’s normal to ingest some bugs every day but your immune system and innate defences like stomach acid deal with them before they can cause disease. Something is going wrong with me.

The standard advice for medication and food poisoning is to just continue to take it as prescribed. I had half hourly diarrhoea but no vomiting so I took my lithium, other mood stabliser, antipsychotic and antidepressant plus the other tablets at the normal time in the evening. But a bit later I couldn’t drink more than a mouthful of water without severe nausea and retching. I could feel myself getting more and more dehydrated as the severe diarrhoea continued. I started getting the bad, coarse tremor and finding it difficult to pick up my mug and coordinate my legs to walk meaning that my lithium levels were becoming too high. I put a repeating four minute alarm on my phone and sat up in bed taking a sip of water at every alarm. It took an hour and a half to drink half a mug of oral rehydration solutions (good tip: if you are taking lithium, get oral rehydration solution sachets so you can make up the drink quickly). I was intensely sedated as the antipsychotic kicked in but knew I couldn’t go to sleep as I had to keep drinking. I think I was actually falling asleep between the alarms. I’m finding this very hard to say, which is weird as this is an anonymous blog, but I was little faecally incontinent as the sedation and tiredness was so strong. Eventually the diarrhoea slowed down and I could drink a little more. I went to sleep for a couple of hours and was much better when I woke up. I could drink normally and my symptoms were gone by the end of the day. But holy fuck was that a horrendous night.

Pre-portioned sachets of oral rehydration solution powder and a mug of the solution.

Food poisoning is unpleasant for everyone but it crossed over into frightening for me because of my medication side effects and the effects of dehydration when taking lithium. Scenarios like this are not something that you are going to be warned about in advance. There are other situations that are worsened, or only occur in the first place, due to medication side effects or attempting psychotherapy homework or trying to follow lifestyle advice. The treatment burden can affect so many aspects of our lives. I don’t see a realistic way of completely alleviating the treatment burden, except by avoiding all treatments, but I think it would be easier to deal with if it was better recognised and acknowledged by healthcare professionals. Even for us, just having a name for this set of difficulties and knowing we’re not alone in it is a relief to some degree and reduces self-blame. That’s something, at least.