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.

My lips are a nice colour

It’s okay for a teenage girl to hate their body. Well, it’s not okay but it’s so common that it’s usually considered normal. (If you stop and think about that, it shouldn’t be.) But it’s just vanity and self-indulgence for a woman in her forties to still hate her body. Surely you should be over that by now? Don’t you know that no one cares what such an old body looks like anyway? Haven’t you built enough of a life where such trivialities don’t matter anymore?

Nope to all three. I made a lot of progress in my late twenties and early thirties with accepting my body as I was part of what was known then as the fatosphere which was a network of blogs and forums about fat acceptance. My weight then would have been classified as obese or morbidly obese so I felt like I fitted in. The arguments for fat acceptance made a lot of sense to me with their logic and their compassion. But while I fully supported the idea that fat people should be treated with dignity and respect and without discrimination, I couldn’t fully apply the ideas to my own body.

When I am manic, I have great body image. I look in the mirror and think I look fucking amazing and any woman or man would be lucky to have sex with me and that people glancing at me will think I look good. When my mood is normal, all I can see in the mirror are unacceptable flaws that make me look terrible and will make people looking at me dislike me. At its worst, I look in the mirror and feel deformed and like I want to harm my body to punish it for being so bad.

The part of my body that it bothering me the most right now is the roll of fat and protuberance of my upper abdomen. I hate it. Everyone seems to hate any kind of bulge in that area too. I never see that area celebrated. The only time it is mentioned is in terms of how risky storing ‘excess’ fat there is for cardiovascular health. My clothes are definitely tighter there since I started intuitive eating and I have had to let my belt out a notch. I am hyperaware of how that area feels against my clothes and that triggers self-critical and negative thoughts about eating, my weight and my body.

I try and be objective and think this is just adipocytes gathering fuel, like they are supposed to. It is just molecules of lipids bundled up in cells. It is just human tissue the same way there is connective tissue on the sole of my foot. But this particular fat means something to me. It means I am out of control and unruly (a word I will always now associate with Roxanne Gay) and that people will judge me harshly and I am not safe. That’s a lot for a small group of cells to carry. It feels very dangerous to risk going against the expectation that I should follow the convention of how to look there. I don’t want to be different. I am desperate to fit in and be normal but I can’t be normal in many areas of my life because of my mental illnesses and past experiences. But maybe I can change this. Maybe I can control this.

I try and be objective again and think that people judging me is just thoughts in their brains. Just biochemistry. But sometimes those thoughts affect real life and real concrete things happen to me because of those judgements. Unlikely to be a problem solely because my upper abdomen is a big bigger but these little judgements mount up and can be devastating.

One of the techniques therapists use to help you re-balance your body image is to list out the things you like about your body. When I was asked to do this, over a decade ago, I couldn’t do it. Not only could I genuinely not find anything positive to say about my body but I also had this overwhelming feeling that I would be doing something wrong to say positive things about it. The first positive thing I ever said to myself when I looked in the mirror was, “my lips are a nice colour”. I astonished myself as it was a spontaneous thought. I still remember the feeling. It was late at night, in the bathroom, and I still have the dressing gown that I was wearing. Another technique (which I always thought sounded like bullshit but it seemed harmless enough) is to smile at yourself in the mirror every time you go to the bathroom. I still do this now and I finally think I have a nice smile. I have also got habituated to my crooked face and can recognise myself in photos.

Full length mirror. Not mine as this would be too much effort to dust.

I looked in the full length mirror while naked yesterday and managed okay. Didn’t have overwhelming self-hatred. Didn’t gaze in disgust at my loose, wrinkled skin from my weight loss. Thought, “yes, my lips are still a nice colour”. Tried to be realistic that this is just a body and it doesn’t have to mean anything. I remembered another therapy technique: think if you were on a planet with everything you need but no other humans; would you be so desperate to change your body, and all that that costs, if no one else saw it? I have gone far enough with body acceptance now to say that if I was alone then I would be fine with my body. I am actually pretty lucky with all that it can do, other than my fucking brain. If I was alone, I don’t think I would give a second thought to how my body looked. It wouldn’t occur to me. So my problem is not my body: my problem is other people’s reactions to my body.

Maybe the technique I should be learning is how to tell other people to get to fuck.

Taking a swing back

[eating disorder, weight numbers]

Yesterday, I listed out all the negative thoughts about my binge on Tuesday. I am feeling a lot better today and want to record how that has happened because chances are that I will binge again at some point in the future. I don’t want to but it’s a very entrenched coping mechanism with me and I am very early on in my learning of intuitive eating. I also have pretty poorly controlled bipolar disorder which means I have some periods of intense, painful emotion that are difficult to deal with (ha, look at me being all reasonable… “difficult to deal with”? More like fucking impossible to deal with.)

It’s all very good talking about challenging thoughts but the thing that really started to even out my mood was going a run yesterday morning. I ran four miles with some one minute walking intervals as per my physio’s instructions as I am recovering from an injury. I felt such relief after I had finished running that I had managed to go. I didn’t really enjoy the run (I don’t think I’ve ever 100% enjoyed a run other than when I was hypomanic and that’s how I got injured) but the sense of achievement afterwards was very soothing to my self-hating thoughts.

I also had a good friend round for lunch and confided a little in her. That made something inside my head unclench and feel relief too. I find it very hard to confide in people. I think I am afraid of being judged and shamed. I feel such overwhelming shame so easily with my own thoughts and I just can’t bear to have that happen in front of someone else. I cry very easily when the shame is triggered and I don’t think I could bear that either.

Going back to the binge: I really thought the intuitive eating was going to stop me binging. I was looking at absolutes: I used to binge and now I don’t. It’s a poor way of trying to deal with the uncertainties of life. It isn’t accurate and it doesn’t work. I don’t have to keep doing things the same way. It was dichotomous thinking (otherwise known as all-or-nothing or black-or-white thinking) and it piled the pressure on myself to be ‘perfect’ and not use this coping technique that has actually given me a lot of benefits over the years as well as the obvious harms.

While I was binging and cruising my kitchen cupboards I kept thinking “oh I can have this now, wasn’t allowed it before”. I have been turning intuitive eating into the hunger and fullness diet. I would only ‘allow’ myself to eat when I was the appropriate level of hungry. That sounds sensible: eat when you’re hungry. But how hungry and for how long? Normal eaters eat for other reasons sometimes too, e.g. celebration, to be socialable, occasional comfort. Whatever new rules I had created in my head, I wasn’t meeting my needs and was triggering feelings of deprivation. Along the same lines, I repeatedly thought I was finished binging only to eat more because I felt like I had to get my fill while I could. I haven’t given myself unconditional permission to eat like the book says is essential. I think I have to really feel like I can eat what I want whenever I want without plunging myself into overwhelming guilt or negative thoughts or any kind of emotional sanction. I let myself eat but then I let my self-hating thoughts punish me for it. No clue how you’re supposed to fix that.

I promised myself that I would not weigh myself in June. I weighed myself almost daily for the almost two years I was dieting. I got very adept at interpreting the fluctuations in my weight caused by my cycle, time of day, my food intake, my salt intake, changes in exercise, etc, and not to mention unexplainable normal variations, but I put much too much value on that number. An unexpectedly low number always cheered me up and a high number would upset me and make me feel hopeless. When I started intuitive eating, I had been dieting so my glycogen stores were low meaning that my weight would naturally bounce up when eating a normal amount of calories. I also thought I would gain some weight as I would be overshooting my eating while trying to discover what comfortably full felt like. So it would be a terrible idea to see that higher number and feel compelled to go back on a diet. It would be another battle in my head that I’d almost certainly lose.

I was feeling better after going a run but still felt like my body was utterly unacceptable and deformed and ugly and had expanded disproportionately in some places. I have had these feelings all throughout my time dieting and they have been significantly worse since I stopped weighing myself daily and having that objective, but imperfect, measure to backup the thought of “your judgement is off again, like it often is, just look at the fucking number”. I told myself that if I was under X+1 stone then I would keep on with the intuitive eating and if I was under X st 7 then I would be delighted. I looked in the mirror and told myself it was a bad idea and then went and weighed myself anyway. I have gained 1.4lbs. Even my relentless thoughts were speechless in shock. I really did expect to be well over X+1 stone going from how my body felt and what it looks like in the mirror. My judgement isn’t worth shit when it comes to assessing the size of my body.

I cried in the shower in overwhelming relief saying “I’m still okay, I’m okay, I’m still okay”. My mood improved considerably, I was almost dazed by how my thoughts lightened and I suddenly had the ability to shut the fuck down the negative thoughts about my body. Talk about overvaluing the number on the scales! I was incredibly lucky to have got that number and to have responded in the typical way to intuitive eating. This could easily have gone the other way and I would have had the opposite, equally extreme, response of self-hatred and plunging back into dieting. Then the inevitable binge-restrict cycle would have started back up.

I have to make the most of this reprieve and make progress on my thoughts and feelings about my body, my weight and my eating. I can’t go back to dieting/restricting and binging. I am working through The Intuitive Eating Workbook which is helpful but I don’t know if it will be enough as these thoughts and feelings are so strong. I think I have learnt from this last binge and my reaction to it though. Blogging about it has made my thoughts more concrete too. I will keep trying.

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.

No spend days

No spend days (NSD) are an idea popularised by several budgeting website to help people limit their unnecessary or mindless spending. I thought it was just a gimmick that didn’t make much practical difference but I made a New Year’s resolution this year to have two a week and I have surprised myself and kept to it because it works.

It’s a very simple idea: you don’t spend any money for a day. Turns out it’s quite hard to do especially if you have got into the habit of being loose with your spending. That quick bottle of water or just nip into the shops for bread or add a few more items to the online shopping basket to get free postage all add up. I use the legacy software Microsoft Money to track and do basic analysis of my spending and I could see that I was spending more and more small amounts on random crap on almost every day of the week. But I couldn’t seem to get a grip and actually pin myself down to cut it out.

When I started the two NSDs a week I found it surprisingly tough. Even the swift in and out of a newsagents for a snack is couple of pounds saved. The other day I didn’t buy an ice cream in a park because I didn’t want to spoil a NSD. I am lactose intolerant so this saved me some gut pain too! I do plan around NSDs and save online shopping for days when I have to go to the supermarket. That means that I do much less spontaneous online shopping. The biggest change has been how frequently I go to the supermarket. It really is true for me that the more often I go, the more I spend on unnecessary things. Something catches my eye or I see an offer on something I usually buy so I then buy more. My groceries spend has come down a fair bit which is very welcome.

What you count as a NSD is up to you. For example, I don’t ‘count’ direct debits. So if on the 1st of the month I have money coming out of my bank account by direct debit but none by debit card and no credit card or cash spending then that is still a NSD to me. Also, I count online supermarket shops on the day that the shopping is put through the till, i.e. the delivery day, rather than the day I order it or do amendments to the order. It doesn’t matter what ‘rules’ you use but it makes things easier if you are clear to yourself about what you want and are consistent.

NSDs are just a little game to play with yourself to help you manage your spending and budgeting. They make something that is usually tedious a bit more satisfying and are well worth a try to help manage that aspect of your life.

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.

Wikipedia‘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.

How big a binge

[eating disorders, description of binging, calorie numbers]

There was research released this week about how much exercise the human body can endure over the long term. Their conclusions were that people can expend two and a half times their resting metabolic rate consistently every day. Above that amount, tissue starts to break down and it isn’t sustainable.

The thing that interested me is that the limiting factor is how much energy the body can digest from food. That is around 4000 calories a day for the average person. You can physically eat more than that but the body can’t digest it. My binges, at their worst, can add up to 7000-8000 a day. That’s three or four big binges plus some other eating over the course of a day. These days, I don’t do any attempts at compensatory behavious like self-induced vomiting, use laxatives or fast. I do overexercise and restrict (diet). Just realised that I’ve written this all in the present tense. My attempt at intuitive eating feels so new that I don’t deserve to say that these things are in the past. I’ve not binged in ten days which is the longest for a long while for me and the binge urges are much more manageable as they are weaker and less frequent.

This screenshot shows my calorie intake from a week of binging this year:

Screenshot of the MyFitnessPal calorie counting app that shows my high calorie intake over a week of binging.

I gained around 5-7lbs that week once the water weight/bloat settled. It should have been more if I had digested all the food I ate. This research explains why.

Of course, the eating disordered part of me thinks “ooh, I can eat as much as I want and it won’t count”. A pound a day of weight gain still! I can’t exercise when I am eating that much as need to be near a toilet for the inevitable gut distress. Not to mention the intense negative thoughts and guilt and shame and self-hatred and suicidal thoughts and pain pain pain. No, the binging still would ‘count’. But it’s interesting to have outside confirmation of an effect I had noticed in my body and dismissed as me being stupid. I’m still aiming to not test it again though.

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.

Why I am trying intuitive eating

[eating disorder, mention of weights, calories]

My eating has been so much better since I read Intuitive Eating a fortnight ago. I have seen snippets and opinions on this book and its concepts on the internet for years. I’ve made attempts at that style of eating before including after my second diet when I gained back 150% of the weight I lost. I wrote it off after that. Reading the book and really paying attention to what I was reading has made me realise the parts I didn’t understand and given me much more complete, authoritative information.

A key part of intuitive eating is giving up dieting and putting weight loss on the back burner so allowing your weight to drift to your natural set point. I have a problem with this concept as from the way I understand set point theory, you can’t really change your set point and mine is (or was, it is likely higher now after dieting again) well into an obese BMI. Yes, I know BMI is bullshit but it’s a rough illustration without using numbers. In the past, if I eat to my appetite then that is the weight I go to. I have gained a lot of privilege and freedoms by changing from a fat (why I am using this word) person into a straight sized person and I don’t want to give them up. The fact that I may have no choice makes me despair. I am still thinking that I would rather be at war (and it is a goddamn war) with my body, my hunger and food than go back to being treated the way I was when I was fat.

For nearly two years, when I decided what to eat, I did it in the calorie counting app MyFitnessPal and followed the rules that I had picked and chosen and labelled ‘healthy’. It was actually a pretty big surprise to me that most people use internal cues (what food looks appealing, noticing when hunger starts inside their body, stopping when their body signals ‘full’) to chose when and what to eat and when to stop. When calorie counting I had a relentless drive to try to feel full and often did not. My hunger signals were numbed though. I just felt stretched and under pressure. That’s because my body was stressed by the calorie restriction. The disappearance of that stretched feeling is lovely. It’s not gone completely though and that makes me worry that I am going to gain a lot of weight. Everything is making me worry that I am going to gain a lot of weight. I am preoccupied by this.

This is what I wrote a couple of days before starting intuitive eating but was reading through the book:

I haven’t given up dieting though I’m considering it. I am very worried about what will happen to my weight if I stop restricting my calorie intake. There are good clinical studies that say that intuitive eaters have lower BMIs than emotional eaters but I think my natural set point is much higher than my current weight (and I am currently five pounds above my chosen target). I had pretty much come to terms with logging my food for the rest of my life. But it was such a battle as I had frequent urges to binge and overeat (or what I would consider overeat) and periods of fucking horrendous binging. The part I am doing is the mindful eating which is no phone, no book and no TV when eating even a snack let alone a meal and really feeling the sensations of eating, slowly and deliberately. I bathe my brain in the sensations of eating. I am trying to eat the foods that sound appealing to me and I really want rather than what is arbitrarily considered ‘healthy’. I have noticed that I do a lot of not eating when hungry in the morning after exercise and eating when not hungry but have scheduled snacks in the evening. My satisfaction in eating has increased dramatically and the urges to binge have fallen away a lot. They are no longer as overwhelming although I have binged three times this month, it was less out of control and much better than the days of multiple binging I’ve had before. I even have moments where I feel at peace with food: like it’s all okay. Which is just goddamn astonishing to me. I would like to reduce the fat on my abdomen but I would also like to have more of these feelings of peace. More dieting or take a chance on doing intuitive eating properly and hope it doesn’t make me gain weight.

If things had continued like that with the reduced binge urges, and maybe even some small binges, then I think I would have just went on calorie counting with mindful eating and putting up with my disordered eating. But I had an out of control binge (thousands of calories) and was plunged into low mood and intense suicidal thoughts. It just seemed ridiculous to be affected so badly. And I was curious what would happen if I followed the principles of intuitive eating properly. I am just so tired of all the fighting. The moments of peace were beautiful and I wanted more. I like routine, and some of mine are quite inflexible, but I was bored of my routine of calorie counting and restricting. The main thing was the out of control binges and the resulting weight gain. I have a hope that if I don’t binge anymore then my weight will drift down again. I also won’t have the mood disturbances and suicidal thoughts. I have the fear of weight gain driving me to try intuitive eating and the fear of weight gain sabotaging me from fully committing to intuitive eating. Maybe I will eventually realise that weight is just not that important. Feeling at peace is important.