Friday, July 29, 2016

Training on Empty: Chapter 29 (Possible TW)

Possible trigger warning with mention of behaviors and numbers.

Chapter 29 – Leap of Faith

“God comes to the hungry in the form of food.” – Mahatma Gandhi Quotes, Mahatma Gandhi  

As with any other addiction, anorexia is a means for someone whose life may feel out of control to establish a false sense of security. Unable to control events outside themselves, addicts control their immediate environment. There is considerable irony in that the addiction ultimately ends up controlling the individual, but there is comfort in knowing that the situation, as bad as it may become, won’t change. Sometimes pain when one expects it is easier to handle than when outcomes are left up to fate. An extreme example of this is when victims of physically or verbally abusive perpetrators start an argument. Knowing when the slap or verbal attack is coming allows them to prepare for the blow and move on more quickly after the fact. Most often, a sense of the world being unpredictable stems from continually being let down by the universe; a parent failing to show love, a relationship ending abruptly, a lost job, a friend’s death. Although addiction temporarily offers a sense of control, everyone knows life is something that can’t really be driven and directed like some Hollywood movie. Going with the natural ebb and flow of nature is the best scenario, but is often a difficult exercise.

After a full day of crying and making calls to various counselors in the Phoenix area, I was told I could not receive financial assistance for any emotional or physical support or treatment until I was a resident. That meant I would have to stay there eight more months before I could afford care. I called my sister. I did not expect her to be so honest and forthright about how she felt. For the first time, she let me know that while she loved me and supported me, she was convinced that getting over an eating disorder was going to have to come from within. She was right; after all, I had spent thousands of dollars on hospitals, alternative medicine, books and therapists with no tangible results. I was like a chronic drunk who attends many Alcoholics Anonymous meetings without actually working the steps, assuming that something outside her could be the cure. While many of these avenues had given me greater insight into the disorder, none helped me overcome the problem. I understood my illness on an intellectual level, but I couldn't put it together in a way that allowed me to heal from it. I needed to take a leap of faith and allow myself to trust myself and trust that letting go didn't have to be such a struggle. There was a part of me that knew a healthier way to live, even if I couldn’t visualize it perfectly. I had just never nurtured that part of me, because I was too caught up in punishing myself. I believed fully in Geneen Roth’s method of living – listening to your body’s inner wisdom and trusting that deep down, you know what your body needs. I knew in my heart everyone could learn to feel what hunger was and know when fullness occurred. What I didn’t realize at the time, though, was the physiology behind eating and fullness and how much that changes with prolonged food issues.

In normal people, when blood sugar drops, the liver sends signals to the hypothalamus alerting the brain that the body needs glucose, the sugar the body breaks down from food. At this point, physical hunger is often experienced when the stomach contracts and the urge to find food and eat is experienced. The hypothalamus also identifies particular foods your body needs and is thought to be responsible for cravings. After food has been consumed, hormones are released and again find their way to the hypothalamus as the food begins to move from the stomach into the intestines. These hormones tell the body it’s time to stop eating. One hormone, called leptin, is released from the fat cells themselves. Satiety occurs after all these hormones have traveled to the hypothalamus. Unfortunately, with both starvation and purging, it’s as if these hormones become downright confused and are hesitant to be released. It takes a much longer time for leptin to be released in a bulimic than in a normal person. This can often trigger another binge because the bulimic actually still feels hungry, despite having just eaten a normal meal. Since anorexics constantly override these hunger signals, hormonal chaos results and delayed hormone release is likely. It takes many weeks of regular meals to establish the hormonal connection that allows one to begin to read and recognize both hunger and fullness. It has been reported that some of the concentration-camp victims in World War II experienced a warped sense of body image. It is also known that some who survived starvation and the harsh conditions of the camps ate so much upon their release their stomachs burst. Clearly, the body this far out of balance is not able to regulate its own needs for survival.

After much consideration, I decided to move back to Boulder where I could at least find support from family and friends. In the meantime, I was determined to allow my body to rule my appetite. I figured I had already hit rock bottom, so anything, even gaining weight, could not be as bad as living the way I had been living. To celebrate my faith that I would survive and live to see a better life, I went out for ice cream, something I had not done in over 10 years. I had sometimes eaten frozen yogurt at home, but to actually go out and allow someone else to serve me was something I had not experienced since my days in college.

I remembered from my stay in the hospital that once my metabolism started working again, I would be hungry. I didn’t realize I would experience an almost frantic need for food. I would eventually have to address both the emotional deprivation and the extreme physical deprivation the years and years of anorexia had caused. At times I would become panicky at the thought of having to wait to eat. I was consuming food every few hours. When I packed my belongings and headed home, I was on a mission to eat exactly what I craved. On my drive to Colorado, I stopped at five different stores in search of a bran muffin. It took an extra hour to find one, but after such severe restriction, I was allowing myself some indulgences. My fear of gaining weight was definitely still right in my face, but it was as if my body had taken over. I didn’t fight my intense cravings, only the thoughts in my head that insisted I was already getting fat.

Unfortunately, after too many sugary meals and far too little protein, I set myself up for another short bout of bulimia. It seemed that no matter how much I ate, it wasn’t enough. Also, for some reason, I couldn’t exercise without crying. It was as if all my fears were coming back to haunt me. I buckled under the past trauma of performing and overtraining, starving and living compulsively. My self-esteem was shot to hell and I was desperate for reassurance that I was going to be okay. I followed my mom around like a little puppy dog in order to feel safe. I felt vulnerable and shy and was having a terrible time trying to regulate my food intake. It seemed that the pendulum had swung in the complete opposite direction and stayed there after being held so tightly on one side. I finally saw a psychiatrist who put me on an antipsychotic drug called clozapine and some antidepressants, including a low dose of Prozac. Eventually I started to reach some balance. I felt obese at just around 95 pounds, only 15 pounds heavier than my low point. This was still very thin, but my weight was creeping ever higher and my fear was that it wouldn’t stop increasing. My psychiatrist told me that one of two things would happen: Either I’d continue to be anorexic or I’d get healthy and end up hating my body. This was a Sophie's choice, and I didn’t believe him. I also couldn’t believe he would say something like that. I knew there were women out there who were healthy and tolerated their bodies. I had even heard of people who actually loved their bodies. I refused to accept those as my only two choices. I quit seeing him and attempted to take responsibility for my own wellness.

Since I was still struggling with a horrible self-image, despite my belief that others could overcome this issue, I decided that in addition to starting to run again, I was going to stop weighing myself. I could not deal with the numbers any longer. They made me crazy no matter what objective story they told, and I obsessed about being a certain weight when the scale was involved. It's terrible to consider how a number could determine how I felt about myself. I knew this then, yet I still couldn’t stand the thought of my weight going above that 100-pound mark. I tried hard to stick to some sort of regular eating pattern: breakfast, lunch, dinner, and one snack. It wasn’t long before I couldn’t stand the sight of myself, though, and I started restricting again.

The next few months were a roller coaster of eating what I felt was too much and then reverting back to sharply restricting calories. I was running again and back to working out several hours a day, mixing the running with biking, walking and calisthenics. It wasn’t long before I was struck down with another stress fracture in my pubic bone. A later diagnosis would show that, over the years, I had suffered several small fractures in addition to the larger one in that area. I took to biking and lifting. I was very shocked at how weak I was. I had no core strength despite all the running and compulsive aerobic exercise, which only burned what little muscle tissue I'd retained. My muscles did not seem to respond to weight training by getting bigger or stronger. Instead, they broke down. It was as if my body no longer knew how to synthesize muscle. I experienced chronic soreness in addition to a general feeling of not moving forward and feeling stuck, yet I continued to work out like a hamster trapped on a wheel.  

A therapist friend of mine and I decided that since I had a tendency toward bipolar disorder, I should stop the antidepressants. She suggested lithium, but I was too afraid of the possible weight gain. I already felt such self-loathing at just over 100 pounds. I couldn’t imagine gaining more weight and living with myself. I had stopped purging, but was still having difficulty finding balance. On a whim, I tried a product called SAM-e. I didn’t notice any great change at first, so I stopped taking it, but a month or so later I realized it had actually been easing the depression I had felt throughout my life.

As for my eating, a combination of what I thought was sensible and what my body was craving seemed the best approach, so I used a variation of the Zone Diet to achieve at least some sort of regularity in my life. I found that eating smaller meals throughout the day kept me from feeling panicky or overly worried. The smaller, more frequent meals kept me from getting overly hungry or weak and also helped keep metabolism going. The smaller meals were also much easier to digest and didn’t leave me feeling as bloated or full. To help keep my blood-sugar levels from fluctuating too much, I made sure not to eliminate entire food groups from my diet. Basically, instead of following any diet in particular, I learned to balance what I was craving with a sensible meal plan. I aimed for a bit of protein, carbohydrate and fat at each meal. Still, I relied heavily on calorie-counting strictly out of fear of gaining too much weight, and letting go completely seemed out of the question.

A few months later, when my stress fracture had healed, I began running again, and I decided I wanted to run a marathon. I knew it was risky, but I wanted to prove to myself that I had the ability to give my body what it needed to run that far. I wanted to prove to myself I could adapt. I needed to show the people around me I had courage, so I started training by running longer runs on the weekends. I knew that on some level I was a bit over the edge but considering where I had been, I was indeed healthier, at least emotionally.

During the time I trained for the marathon I met some amazing new people, people who showed me the meaning of true friends. Unaware I was continually complaining about how fat I felt, I was confronted by my running partners. They said that while they loved me, they didn’t want to hear me say “I feel fat” anymore. This led to a change in my conversational habits that ultimately helped ease the actual feeling. The more I moved away from saying that I felt fat, the more I moved away from actually feeling fat. Eventually, I even thought about it less. The noise of these obsessive thoughts was decreasing over time. When I began to have panic attacks, another friend, Misty, suggested I wasn’t eating enough. She pointed out the pattern of my panic attacks and suggested I try eating a bit more each day. She said, “Look, you know that what you’re doing isn’t working, so just change.” I laughed, “What?” I couldn’t “just change.” Or could I? I had never thought about it, but she was right. “Just try something different for a week, and if it doesn’t work, you can always go back to what you were doing before,” Misty said. “Chances are, though, you won’t want to. If all else fails, try something completely different” And all of a sudden, I saw not one way out, but many. Infinite options were before me.

Change is hard for most people. It’s even more of a challenge for anorexics. They tend to set rules in concrete and develop rituals that may appear meaningless to others but are as essential as a life-sustaining breath of air to them. In addition, they are some of the best game-players in the world. No matter the extent to which rules around food, deprivation, and exercise threaten their lives, they will do what it takes to stay the course. It’s easy for an outsider to suggest that they just eat something, simply change the rules, but this is nearly impossible for someone trapped in the grip of such an illness. The desire to be well may be there, but the means to becoming well is missing. The thought of simply eating something outside the rules set is just not an option. There is no going cold turkey with anorexia. Unlike stopping other addictions, it’s impossible to have an all-or-nothing avenue for recovery. Instead, it’s more a matter of gradual change, baby steps. Although the analogy of a smoker having to smoke only half a cigarette is not quite accurate because cigarettes are not ultimately healthy for the body, in terms of addiction, the difficulty of this scenario would compare to what an anorexic has to do in order to recover.

When it comes to eating disorders, it often takes someone outside to allow for the permission of a change in the rule book. At times when exhaustion from dealing with the disorder and all that it brings sets in, an anorexic will welcome outside help and agree that someone other than herself needs to step in and take control. It takes an enormous amount of strength for this change to come from within. Whether the initial change happens as the result of allowing someone else to take control or from allowing the body’s needs to finally be heard, it is the only thing that will ultimately lead to recovery. Finding self-worth and discovering self-love are integral parts of reclaiming health. Simply gaining weight is not the cure to anorexia, and it's essential to feel worthy in order to heal. Listening to the inner self – the self that longs to live and be free and play by rules that are not so strict – is the real cure.

Anorexics have a tendency to see the world in black and white. It’s either-or; there’s no living in the grey. It occurred to me in the middle of my conversation with Misty that eating didn’t have to be a matter of starving or being fat; it could possibly be something in between. With this broad new view of my once-limited world, I was able to occasionally add snacks to my daily diet as needed. The panic attacks were fairly manageable and seemed to lessen with proper nutrition and by avoiding caffeine. The panic attacks would eventually get worse, but at the time they were not overly worrisome. I finished the marathon almost completely anonymously in an unimpressive time of 3:49 that included two stops – one to talk to a friend on the sidelines and one to use the portable toilet – but I found that I had accomplished a great feat. I had discovered my ability to listen to my body.

I would find out later that listening to my body could be disrupted and would become nearly impossible with so much damage already done to it. For some unknown reason, my body was continuing to break down despite an improved diet and a strict “no purging” policy; it was as if I had passed some physical point of no return, like a former smoker who quits too late to keep her emphysema from gradually worsening in spite of having given up cigarettes. And so it was that just when I thought I was getting on my feet, I faced the fact that despite not yet being 35 years old, I might have already caused irreversible damage to my body.

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