Words Matter

I'm in the process of moving things over here: https://chaoswithggirl.substack.com/p/words-matter

Earlier today, I saw that Oiselle posted the following on Twitter:

When we separate the athlete from the person, we are essentially saying, “You need to sacrifice your mental well-being to achieve success in the sports world.” This is not okay.

Since I had basically just written the opposite regarding separating the person from the athlete, I read the post several times before thinking, "What the fuck?" When I clicked on the link to the article Oiselle had referenced, I quickly realized that there was an error in wording. The bigger message is something I absolutely agree with and endorse, that of being open and willing to talk about mental health, and Karelle Edwards did a lovely job of sharing her story and encouraging others to do so as well. After all, according to a well-researched article published in 2019, "elite athletes experience broadly comparable rates of mental ill-health relative to the general population in relation to anxiety, depression, post-traumatic stress, and sleep disorders." There's no reason anyone in sports should be ashamed to come forward when close to 35% of elite athletes will suffer some form of mental health issue. It's critical that people in general, but athletes in particular, move away from any negative stigma associated with mental illness. 

The wording in the Oiselle post and article is an issue, though, and this is unfortunate because, as I said, the larger message is a very good one. I don't fault the author, really. Her overall concepts are spot-on; I fault those who published the article and then spread a potentially harmful message on social media. The Twitter post is misleading. The author's sentiments are actually fairly clear despite the error of suggesting "you can't separate the athlete from the person." Not only can you separate the athlete from the person, you absolutely should. What the author seems to mean is that one should take a holistic approach when dealing with athletes. Being allowed to show emotion, be emotional, show vulnerability, and support others in need is a healthy approach both on and off the athletic field. Integrating being human with the experience of being an athlete is not the same as being enmeshed with your emotions or tangled in your identity as an athlete, though. It's very, very important to be able to make the distinction, and Oiselle did not. 

To a degree, forming a positive "athletic identity" can be beneficial, but when it goes too far and an individual can't separate himself from that role, the label becomes problematic. A sport is an activity a person does, not who she is. In 1918, the journal of Qualitative Research in Sport, Exercise and Health published a study that suggested that adapting to retirement is more difficult for elite athletes than for the general public. When elite athletes are no longer competing at a high level, they may struggle to find a sense of purpose in their lives, especially if they haven't allowed for growth in other areas or if they are too wrapped up in their identity of being an athlete. When it comes to athletes, Malcom Lemmons cautions, "What they did in sports should never become who they are. And this goes for every athlete, currently playing or retired. Your ability as an athlete and the success you used to have should never overshadow your other abilities as a person." 

When I speak of the emotional, physical, mental, and even spiritual bodies of a person, I'm not moving into woo territory. This is just a more well-rounded look at the individual as a whole. My first college coach used to ask, "Are you physically tired, or do you feel like you don't want to do the workout?" Physically tired meant my legs were sore, I didn't sleep well, or I was drained and lacking energy. Emotionally tired could present as physical symptoms, but, in that case, we took a "warm up and see" tactic. If, after a warm-up jog, I was still fatigued, it was time for an easy day or a day of rest. If my body felt better, I could jump in the workout. The best thing about my coach was that he always looked at us as individuals first, athletes second. If you nurture the person, the positive results should spill out in all areas of life, including athletics. 

I don't want to take away from Edwards' necessary and heartfelt message of getting help and being free to open up about mental health issues; I just hope that everyone can be more aware of how much words matter. The idea that a person be allowed to be who she is in everything she does is a good one. The problem is Oiselle wording the social media post in a way that suggests merging identities, which can be very unhealthy and doesn’t appear to be what the author means anyway. A little caution on social media can go a hell of a long way. 

Just How Broken Are Things?

Don't ever, ever, EVER, ever, EVER, ever, eeeeevvvveeerrrr, ever, ever EVER, ever go to Let's run if you want to avoid misogyny, hate, and comments that are even worse than those found on YouTube. Good god, that place is a cesspit of toxic waste. Online misogyny has increased in general over the last few years, but on Let's Run it's extraordinarily virulent.

When I recently saw one thread on Let’s Run about Mary Cain's allegations against her former coach, I was disgusted and felt physically sick. It's clear that the majority of individuals commenting are not exactly psychologically astute, but what's most disturbing isn't just seeing a complete lack of awareness of any given subject plastered all over a particular forum. The intentionally degrading and vicious comments are what's so shocking. Despite an obvious lack of knowledge about development, health, and quite a long list of other topics, it's surprising how vocal these arrogant individuals are when it comes to pretending to know what's best for other people, especially young women.

As I expected, people coming forward suggesting the solution to avoiding any kind of body image or eating issue is simply to resist being attached to a number on the scale opened the gate for others to misinterpret the bigger picture, which is that some women can have a positive experience and stay healthy throughout a running career. And heaven knows that's a message we all need right now. However, people look at what was meant to be a few words of hope and support (I think) and twisted it to make it seem like the real message is really that those who don't rise above it all are weak, which some of us expected, but not to this extent.There has always been an incorrect idea floating around that any addiction or mental illness can be overcome by will power. I’m just surprised how many people still believe this myth.

I've been saying it for a long time now, but these are not just women's problems. As much as some will point the finger at what they consider weak females, more than one in ten men suffer from depression in the United States, and male athletes are even more prone to depression, anxiety, and suicidal thoughts. In 2014, the American College Health Association found that, in their survey of about twenty thousand student-athletes, 21 percent of males reported feeling depressed, and 31 percent of them felt anxious. According to the National Collegiate Athletic Association, suicide is the third most common cause of death among student-athletes.

Some of the ugliest comments I saw on the running forum suggested a young girl is a wuss for crying or struggling, you know, being human. They insist Mary should have just lost the weight her coach wanted her to, despite the fact that she was already physically breaking down. Imagine what a lack of proper nutrition does to the brain and how that affects emotions. But even if there were no link to emotions and being properly rested and fed, why would anyone call a young girl weak for reacting to a shitty situation with frustration and tears? It seems quite normal to me. How else was her teenage self supposed to act?

I'm not going to fully address the negative comments Mary's teammate may have said. If it's true, whoever said it has to live with herself and her insensitive attitude. If true, it just shows how ill-equipped people are when it comes to handling someone else's pain and suffering.

My first year in college, I had a mini meltdown before a big workout when I felt frustrated that I couldn’t keep up with my teammates in our warm-up run. Fortunately, three of them stopped and comforted me. That’s all it took. My coach talked to me when we got to the track, and the support I received allowed me to put my frustration aside and get to work. That kind of compassion and understanding doesn’t happen in a toxic environment. Instead, the one struggling is left to internalize all her bad experiences, which only makes things worse.

The bottom line is that mental illness needs to be taken more seriously. We will never fix the problems related to abusive coaches in the running community if there's a refusal to take into consideration the mental health of athletes as well, and that applies to all sports. The two issues go hand in hand.

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.

* * *

Training on Empty: Chapter 26 (Possible TW)

Possible trigger warning with mention of behaviors and numbers.

Chapter 26 – Fear

“What is life? It is the flash of a firefly in the night. It is the breath of a buffalo in the wintertime. It is the little shadow which runs across the grass and loses itself in the sunset.” – Crowfoot, Blackfoot warrior and orator

Sometimes a person can get so caught up in a certain identity that he forgets who he really is. There are others who are more spiritually evolved who have an innate knowledge that who they are is not based on how much they make or what car they drive or even how fast they run. Self-acceptance is not often taught in this country. Celebrating yourself just because you exist is something I wish I had learned. Instead, it’s something I’m still trying to grasp.

By the time I reached 80 pounds, I had become so good at deception that I was even fooling myself. I was still honest as far as admitting I had eating issues, but I was so lost in the disease I could no longer decipher what was good for me and what was not. I was giving myself enemas daily, pretending it was helping rid my body of “toxins,” something I was told by a “healer.” Looking back, I realize that these enemas simply made me feel thinner, nothing more. That was the reason I continued to do them, not for any possible health benefit. My new identity was entirely wrapped up in my illness, and there was an incredible amount of fear around all of my actions. I was outright terrified of gaining weight at that point. I convinced myself and tried to convince others that the diabetes and other symptoms of anorexia were actually what caused the anorexia to become so severe, when in reality it was the other way around. The anorexia was causing all the other issues. It’s an odd thing; on some level I knew I wasn’t fooling anyone, yet on another level I actually believed my twisted explanations. I had lost sight of how thin I actually was. On the other hand, I was fully aware I was sick. People on the streets stopped and stared, mouths fell open when I walked by and looks of concern and fear surrounded me. Occasionally, someone would actually say something about how thin I was, but it was rare, not like when I was heavy as a child when everyone insisted on offering an opinion. Somehow being ridiculed for being fat is much more acceptable than being singled out for being thin, even though they are just different manifestations of the same core issues.

Like many anorexics, I developed little checks to reassure myself I was okay, i.e. thin enough for the day. My basic check was to wrap my hand around my upper arm to make sure my middle finger would touch my thumb. At one point, my check was to feel my hip bones, something I did continually throughout the day, even though I knew it was impossible to gain enough weight to change that drastically in a few hours. These were rituals that, over time, became habit. There were also lies and rationalizations that constantly fell from my lips. They weren’t outright intentional lies; “I ate earlier” didn’t seem like lying. I just didn’t tell anyone how much earlier it was when I last ate, and a “huge lunch” is all relative. My dedication to being honest was unintentionally waning and the line between reality and fantasy became more blurred in my head.

Looking back, I can see how I fooled myself in order to hang on to my eating disorder. I wanted to justify what I was doing, so that I didn't come off as sick to others. I rationalized and tried to explain away my quirky behaviors, hoping those around me wouldn't think I was anorexic. I don't think I was very convincing, but I continued trying to hide my disorder. Being on the other side of the illness, I now understand how frustrating it is to hear someone try to explain her strange behavior that doesn't support health with bizarre and irrational excuses.

When I see anorexic people today, I can detect rather quickly how far into the disease they are without taking great notice of their actual body weight. It’s one of those “anorexics can’t fool other anorexics” phenomena that occur once anorexia has been experienced on any level. It’s obvious when the anorexic is visibly thin, but there are other indicators. Aside from the little checks they do, I can see the illness in the eyes. Anorexics have a certain look. If it’s severe, the look is vacant. If the person is recovering, the look is pained and deep.

By the time I had my first seizure, I was completely lost. I had recently given most of my possessions away, thinking the end was near. I could feel myself slipping further and further away from the world around me. Consumed by obsessive-compulsive behavior, it was a struggle to make it through the day. It seemed that the thinner I got, the worse the OCD symptoms became. It got so that picking out an apple at the grocery store was an impossible task. I felt like Persephone seeking out prettier and prettier flowers in the fields. Each time I would settle on an apple I thought might be okay, I’d think maybe there was a better one. Only very rarely could I actually choose one that was acceptable. Finding the right one actually had little to do with size, shape or ripeness, it just had to “feel” right.

I’m sad to say that even after my first seizure, I wasn’t ready to make an effort to get well. It would have been difficult even if I had been ready, because my finances were pretty well exhausted. Any treatment facility was out of the question. Besides, I felt I was losing the fight. Being healthy takes balls. Claiming the right to life and having radical trust in the universe is not for the weak. Embracing self-worth and self-wisdom takes an enormous amount of sheer strength and faith. I don’t mean that in the typical religious sense, but faith nonetheless. Simply put, being human takes energy.

Because I had become so sick, I no longer felt like a woman. Even in high school, when I was so thin, I had a sense of my femininity. However, once I become so terribly emaciated, I felt asexual and made little effort to dress or care for myself except for basic hygiene. It was more important to me to remain thin than to evolve as a person, even though on some level I wanted to be well. The worst part during all of this was that I could feel my mind losing ground. Up until that point in my life, my mind had always been razor-sharp and overactive. Thoughts flooded my brain and creativity oozed from my very being. All of a sudden, I was living in a haze and experiencing things in slow motion. Then, horror of all horrors, I felt my thoughts escape the bounds of my own control.

As hard as I tried to focus my mind by reading or concentrating, I just couldn’t. What I didn't know is that my serum sodium level was dangerously low; I had diluted my electrolytes through excessive water intake, and this condition – called hyponatremia – was causing my brain to short-circuit. Complete and utter panic grabbed me to my very soul and I knew something terrible was happening. Instead of calmness and nice white lights near-death survivors often claim to experience, I came face to face with paralysis, blackness and complete loss of control. After the seizures would pass, I would remember bits and pieces of the events leading up to the seizure itself; the tingle in my back, the repetitive thought that was stuck on replay, and the screaming that came from my mouth but seemed so far away.

Each visit to the hospital was expensive. The ambulance ride alone was close to $1,000 per trip. My insurance company had dropped me after my second hospital stay, so my parents footed the bill. After I was told the seizures were not exactly life-threatening, I wore a small necklace with a sign attached to it that read, “in case of seizure, please do not call an ambulance.” After two trips, my parents couldn’t afford to pay for another ride for me.

When I woke up one night to severe chest pain and shortness of breath, I thought for sure that was it. My mom and I took a cab to the hospital, where the doctors told her not to expect me to make it through the night. I begged them to find room for me at an eating-disorders treatment facility. Their response was, “Sorry, they’re full.” I looked at my mom and asked, “How sick do I have to be?”  Clearly I was going to have to figure this out on my own. The real question was: Did I even want to get well?

* * *

Training on Empty: Chapter 7 (Possible TW)

Possible trigger warning with mention of numbers and behaviors.

Chapter 7 -Running on Empty

“Tough times don’t last but tough people do.”  – A.C. Green

I struggled with anorexia for over 20 years. Throughout this long battle I had periods of relative health and periods of severe illness, but what is most surprising is that for approximately eight of those years, I was one of the top runners in the nation, setting records and winning races around the country. Though I survived, my story isn’t pretty, and I suffered long-term consequences from starving myself while training intensely.

Training without proper nutrition can lead to many complications, yet it’s common for athletes to restrict their nutritional intake in order to achieve a lighter weight. According to world-renowned running coach Bobby McGee: “From a plain exercise physiological point of view, the lighter the runner, the higher their VO2 Max. This is their ability (measured in milliliters) to utilize oxygen per kilogram of body weight. This is a key performance factor in endurance events. The lighter the athlete, therefore, the better they perform – hence the warped ‘reward’ that these athletes receive for losing so much weight. Of course this period of heightened performance is finite as the effects of the illness start to shut down the system with its all too often inevitable outcome – terrible, terrible illness, anguish and even death.”

In addition, he states, “Athletes I have worked with over the last 25 years have displayed a myriad of conditions: ketosis, where the athlete begins to metabolize their own tissue (protein) for energy; dysmenorrheal, where the regular menstrual cycle becomes erratic, possibly due to too little body fat (I see the cut off at around 13%); amenorrhea, where bleeding ceases all together, which leads to losses in bone density, stress fractures, and eventual osteoporosis. There is obviously a great deal of mental and emotional stress in both the short term and the long term. The possible replacement of the eating disorder with an exercise addiction can also alter the nature of the situation psychologically.”

Bobby is clear that the long-term effects can be persistent and extremely detrimental. He further states, “The ability that the athlete displayed as a result of an increased VO2 Max due to weight loss in the early stages is rarely regained fully. The focus becomes the disease and the running a fantasy that harks back to a time when the condition was insufficiently advanced to warn those able to help.” According to Bobby, it is also evident that women can suffer erratic menstrual cycles and ill health long after normal eating habits have been restored. The “female triad,” the condition to which Bobby alludes, is a term coined by The American College of Sports Medicine that comprises three conditions: disordered eating, amenorrhea, and the loss of bone density, or osteoporosis, with the first two derangements leading to the third. The body is resilient, but not immune to self-abuse, especially the longer the abuse continues. If an athlete continually trains or overtrains on too little nutrition, it’s possible she may never return to normal health.

At the time I was running well, I felt indestructible. The thought of a compromised body or ill heath later in life never crossed my mind. As with any addict, even if I had some concept of what life might be like, I was too caught up in my compulsive behavior to truly grasp the possible outcome. Like a rebel teen who knows that smoking can cause lung cancer but does it anyway, I was too dedicated to my addiction to change my path. There were people who tried to warn me that I was heading down a dangerous road, but I refused to listen. The addiction was feeding something lacking in me. My running success gave me the attention I didn’t get growing up, and the compulsions distracted me from my past. Though I did suffer several minor injuries early in my career, such as a pulled Achilles tendon and several sprained ankles, I didn’t consider the long-term consequences of what starvation can do to the body. My sole purpose in life was to run and feed my addiction of eating a certain way while exercising intensely. Despite knowing some basic physiology of the human body, it seemed impossible that I could actually die from not eating enough. In the end, I came close to dying, but I was fortunate enough to survive. Whether it was my will to live that eventually made an appearance or something out of my hands that caused me to last, I consider myself lucky in terms of remaining on the planet.

In March 2006, Alex DeVinny, the 2003 Wisconsin state champion in the 3200-meter run, died from cardiac arrest related to anorexia. She was 5 feet 8 inches tall and weighed around 70 pounds at the time of her death. In a September 14, 2004 New York Times article, "When Being Varsity-Fit Masks an Eating Disorder," author Paul Scott addresses the tough position a coach can be put in when it comes to girls and running. He states, “Looking back, her coach, Dan Jarrett, questions himself. ‘I did not understand how someone with anorexia would be capable of making decisions that weren’t in their best interest,’ he said. ‘I totally failed to grasp what it meant.’ He is so troubled by her death that he has since quit coaching girls.”

Former Fairview High School cross country and track coach Joanne Ernst knows first-hand how difficult recognizing and treating eating disorders in runners can be. In an interview, she expressed her concerns as a coach. “It’s difficult to know how to intervene,” Joanne admits. “There is new science today that helps confront the issue, but the information is still changing.” Often, eating disorders such as bulimia can go undetected by a coach. In Joanne’s case, she was lucky to have relatively few runners who suffered from an eating disorder in her years of coaching at the high-school level. When Joanne did encounter one athlete who was visibly too thin, she had a talk with the girl’s mother and suggested that the girl not join the team until she was at a more reasonable weight.

In general, to help runners avoid injuries and other running-related issues, Joanne had a just a few simple rules that she had learned from her own experience as a professional athlete. Number one: Comments about weight were to be avoided. Good nutrition was emphasized, but there was no exact diet given or ideal weight mentioned. And number two: The running program was not based on high mileage. Instead, it was more about quality training, covering the basics of good training and nothing more. With the help of several assistant coaches, Joanne ran a very successful running program for eight years.

The job of a coach is not an easy one. A good coach relies on open, honest communication with his athletes. If the information given is skewed, coaches are not able to make sound decisions regarding the appropriate kind of training for their athletes. For an athlete with an eating disorder, it’s common to bend the truth. Lies about how much training is taking place are the most common breach of trust in the coach-athlete relationship. Food intake and actual weight can be an issue as well. Scott also addresses this issue in his article: “Even the best-trained psychologist can have a difficult time filtering through the deceptive acts and statements that can accompany an eating disorder.

And yet coaches have long been encouraged to identify a syndrome of under-eating, known as the female athlete triad, to help athletes avoid osteoporosis, stress fractures and – in rare cases like Ms. DeVinny’s – even death.” Unfortunately, most coaches are neither equipped to deal with identifying the specific symptoms that lead to the female triad, nor trained to detect the deceitful acts in which anorexics engage. By the time I entered high school, I had already been anorexic for over a year, so I was very good at deception. Most people had no idea what kind of struggles with food I had. They assumed I was thin because I ran, not because I was afraid to eat. Running was something I did so that I didn't feel so guilty about eating. In the end, I allowed myself the reward of eating because I ran; even though I understood intellectually that the body needs caloric intake even at rest, I couldn't embrace it on an emotional level.

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Interview With Suzy Favor Hamilton

In 2012, I did an interview with Suzy for Competitor.com. Recently, I caught up with her again for another interview, this one about her book, "Fast Girl". Thank you, Suzy, for your thoughtful responses and for helping to raise awareness about mental illness. You are forever an inspiration both on and off the track. 

Suzy Favor Hamilton's book, "Fast Girl" covers her life as an Olympic runner and, later, as an escort in Vegas.

Interview with Suzy Favor Hamilton 2015

What was it that got you interested in running, and how old were you when you started?  

As a young girl around age ten, I discovered my love for running while running in the woods and pretending to be a horse. It felt so natural, and it made me feel happy. I didn’t understand what it was doing to my brain at the time, but I quickly clung to it.

At an early age, you seemed to be a perfectionist, determined to be the best. What were some of the outside forces driving this need to be number one, or was this something that was entirely internal? 

It was mostly internal. It’s been pretty well established in the book and other media that I felt this need to please, this need to bring happiness and pride to my family through my running, making up for what I saw as a family in silent pain from what was happening with my brother and his illness (bipolar). I saw the effect this had on my parents and wanted to do my part to make them happy. This only increased as time went on. 

My dad was very involved with my running, and that put a silent pressure on me.  Back then parents had to be involved because young runners needed to travel to other states for the big races. There weren't many local races to run in. I began to feel at a very early age that I had to be perfect, not necessarily who I wanted to be. I believe a factor in what happened in Vegas was this repressed desire to finally be the “bad girl”. I really believe that, as do my doctors.

In your book, you mention that your brother was bipolar. How was it growing up with someone who had trouble regulating his moods? How did you and the rest of your family cope? 

It was extremely difficult because it was never really explained to me growing up, not as well as it should have been anyway. I saw his anger, his recklessness, his overall misbehavior, and just could not understand it. I just wanted him to STOP! My parents did what they could for him as far as getting medical attention, but it was never discussed in the family, at least not with me. Nobody really understood it. I know they tried to shield me from his behavior, but it was impossible to do. The focus was more on the behavior and not the illness behind it.

Despite tremendous support from friends and fans, you have been strongly criticized for coming off as insensitive to those around you while you were working as an escort. Can you give critics a better idea of what it's like to be driven by an imbalance of neurotransmitters, especially in the manic phase of bipolar disorder? 

For me, during that 1.5 year period, I was in a pretty constant state of mania. My doctors attribute this to the Zoloft, an anti-depressant I was put on in early 2011. With the illness, comes this insatiable desire to get and keep the high. You do all you can to get it, even if it’s at another’s expense. It comes across as selfish and narcissistic, attributes often associated with mania / bipolar. You also can experience irrational thinking and behavior. While I knew what I was doing and made the series of decisions I made, looking back, I cannot say I made them with a clear mind. Sex was always at the forefront of my mind, and I acted accordingly. It all seemed perfectly rational to me at the time. My husband was the one I saw as irrational. Why was he objecting to my behavior? I was happy, independent, in control of my life, for once.

I mentioned in a recent blog post that the drug Zoloft is a dopamine reuptake inhibitor. Too much dopamine in the brain can cause unwanted behavioral changes, especially in those who are bipolar. How did Zoloft affect you when you were taking it?  

It triggered my mania, in a HUGE way. I went on it in March 2011, and my husband and I had our threesome in May, which kind of flipped the switch for me. You see, I had never been diagnosed as bipolar. I went to a general physician who, after a 10-minute consultation, put me on Zoloft, an anti-depressant. It’s pretty well established that this is a huge “no-no”. Now, she didn’t know I had bipolar. I didn’t know I had bipolar, but what I wish she would have done is refer me to a psychiatrist. This is evidence of how poorly the current medical system handles mental illness. I was never asked whether there was bipolar in my family, whether there was mental illness in my family.

How have your parents, your family, and your husband responded to your book and your speaking engagements around mental illness? 

Everybody has handled it at their own pace and comfort level. Some show their support in different ways. I’m appreciative that my parents, for example, love me and want what they believe is the best for me, but I think it’s safe to say they don’t understand my behaviors, were not very supportive of the book and would prefer me not to speak about mental illness. At one time, that angered me, but I’ve come to realize I can’t force it. They have to go at their own pace. It has to be mentioned that they have had to deal with the shock that their daughter was an escort in Vegas. I get that they’ve had difficulty understanding, and am grateful they show any level of support they can. I know they love me, as I do them. 

My husband has been great, very supportive, though this whole book ordeal has been very stressful for him. I know he’s looking forward to the hype dying down, as it’s beginning to, and us moving on with the rest of our lives. He’s been doing his best to help keep things manageable for me, but it’s been tough for both of us behind the scenes.

People have also criticized you for including vivid descriptions of the sexual activity you engaged in while in Vegas in your book. With the understanding that anyone writing about their vice, be it alcohol, shopping, food or gambling, it seems nearly impossible to describe what was going on for you without including at least some of these details, but what would you say to anyone who thinks you went too far?

The sex is in there to show how out of control things got, to show what was happening in my undiagnosed bipolar mind, which was being fueled by an anti-depressant that was triggering constant mania.

And, you have to understand, the publisher/editor has more control here than most probably realize. In the memoir, we had over 500 pages to give the editor to work with, and the editor obviously preferred focusing on the Vegas stuff. I suppose in some people's eyes, sex sells. I would have rather had fewer details relating to sex and more information about recovery, and I communicated this. Fortunately, some of the passages relating to sex were removed, and more mental illness education was added, along with a recovery prologue. It’s not exactly how I wanted it, but I think it’s a good, effective book that many are relating to.

Have people struggling with bipolar disorder, anxiety or eating disorders reached out to you specifically because of this book, and, in turn, have any readers offered helpful suggestions to you regarding mental illness and any struggles you have or have had to face?  

Yes, both. This has been the rewarding part for me, seeing that sharing my story has helped others. Literally, hundreds of notes where someone says they totally relate with my story have come my way. Reading my book gives them the feeling they are not alone. They thought it was only them who felt the way they do, and many are now willing to talk about it with others, get help, etc. Many people have shared with me they have taken an anti-depressant with adverse effects. Reading what I went through gave them inspiration to look at things differently, to get help, etc. Many letters from family members of people affected by mental illness have also come my way. My story seems to help many of them better understand what their loved ones must endure.

In your book, you mention that you lost a lot of weight while you were working as an escort. Do you feel you were dealing with any traces of the eating disorder you had overcome earlier in your life, and how are you doing with that now?  

My eating disorder was related to the lack of control I felt I had in my life when I was young. Also, it was related to the unhealthy perception I had to be thin, to be a faster runner.  When I was manic, though, it was more that I just lost my appetite, and food was something I wasn’t thinking about. I was too driven by the mania to have clear, rational thinking.

How quickly were you able to find a medication or a combination of medications that worked for your bipolar illness? 

I was diagnosed in about two to three weeks. Then, I was put on a mood stabilizer called Lamictal, but at a very low dose, as the primary side effect is a rash that can actually kill you. Once we realized that I did not get the rash, the dose was increased. I started noticing a difference after about two months. During this time, they kept me on Zoloft (the anti-depressant) since they knew I was more susceptible to depression during this time than ever. Once the Lamictal kicked in, then I was weaned off the Zoloft. At that point, it was difficult for me, because the Zoloft always made me feel good/manic. The Lamictal calmed me and provided more clarity, but I missed that high of the mania. I took Xanax for times of heightened anxiety, and still do. I was also put back on the birth control pill to take care of mood swings associated with my period. I had been off that for several years.

Do you think people who are bipolar are diagnosed properly and effectively? 

While some are, in general, I would say, no. One in five individuals eventually diagnosed bipolar are misdiagnosed with depression initially (as I was). Too often, general physicians do the diagnosing and prescribing of medications, as is what also happened with me. The system must change dramatically to make sure everybody has access to a psychiatrist for the correct diagnosis. The good news is that once properly diagnosed, there is hope. Effective medications, therapy, reduction or elimination of triggers and support can all lead to a fulfilling life.

Did your husband see what you were doing as simply a compulsion or a phase that might eventually pass, or was he concerned there was something more going on with you? 

You could say we were leading a life of separation in the months leading up to my escorting. I convinced him on the open marriage concept, as there was very little intimacy in our lives, but we both wanted to stay married primarily for our daughter. So, when I started seeing a male escort and hooked up with a couple of guys, he saw it as a phase, just a girl who had been repressed much of her life experimenting and finding her sexuality. Once the escorting turned into more than a one-time arrangement for discreet sex, he realized something more was going on. From there, it was constant conflict between us.

How did the two of you protect your daughter from any negativity relating to this situation, both in terms of the tension between you and your husband and also the choices you were making, and how have you dealt with explaining to her what happened? 

While I knew what I was doing should remain hidden from Kylie, it was all Mark who did the protecting during this time. She saw us argue a couple of times, but, by and large, our arguing took place when she wasn’t around. Mark focused on what he could control. He learned pretty quickly he could not control me, but he could protect Kylie. Most of his efforts went in that direction. I will be forever grateful that he protected Kylie during that time and never tried to turn her against me.

As for the aftermath and how we handled Kylie, Mark and I separated for a few months after I was outed by the Smoking Gun article. It was best for me to get well first before we tried to work things out. So he and Kylie stayed in Wisconsin, while I was in California getting treatment. Mark would bring Kylie for a quick visit every three weeks during that time. 

Kylie knew before all this that I had dealt with depression, so she had a rough understanding that my brain didn’t work quite right. When things got really crazy after Vegas, he just emphasized that point more. “That’s not your mom.” “She needs to get well.” “She’s going to get well.” As things progressed, I started to come back to Wisconsin every couple of weeks, and gradually, very gradually, things got better. It took about 1.5 years before we really had a healthy family life again. It took lots of therapy, including lots of talking with the psychologist and other experts on how to handle things with Kylie.

As a result, she learned what I had been doing in a kid-appropriate way. She knows about sex. She grew to understand as well as she could. We saw her understand mental illness and encourage her, like everyone else, to focus on the illness and not so much the act associated with it. As a result, we have an incredibly compassionate, and very aware 10 year old. I would say she understands mental illness better than 99% of adults out there. I don’t think we give our kids enough credit for what they can handle sometimes.

Do you feel you understood the potential consequences of the risks you were taking when you were in Vegas? 

Absolutely not. I felt I was untouchable. I felt my husband, the only one trying to pull me out, was being an unreasonable ass. This is the stuff that hurts the most today. I look back and see what I put him through.

What was the turning point? In your book, it seems to be the article that caused you to look more closely at what was happening in your life. Do you think you would have eventually reached a turning point without being outed? 

I believe if I were not outed, I would have kept going with my life in Vegas. I was beginning to engage in riskier and more reckless behavior at the time I was outed. I was picking up clients outside of the agency, in bars. I was taking ecstasy and cocaine was being offered, and I was getting closer and closer to saying yes, anything to bring the thrill up a notch. If I had to guess, I would have become addicted to drugs and kicked out of the agency. Mark would have left and taken Kylie away. I would have gone into a very dark place, and either overdosed or taken my life. I know it sounds dramatic, but that is the path I was on.

There are times you speak in the third person as if Suzy and Kelly are two different people. Do you try to integrate the two and accept that they are both parts of yourself, or do you really feel like Kelly was a different person? 

I try to separate the two, as that person was not the person I am right now. That being said, there are bits and pieces of Kelly I admire and try to bring into my current life. She had a voice. She was a badass. She was independent and confident and certainly not ashamed of her body or her sexuality.

Was there ever a time when you felt you were working in Las Vegas for the money? 

Well, it was always a factor. It enhanced the thrill, the taboo of the whole thing. I had a plan to make enough money so my husband could quit his job, the job that I saw as destroying our marriage. Remember, this was my unhealthy brain at work here.