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Archive for the ‘Voices’ Category

(… or reflections on our anorexia journey)

The uni break went so quick. One minute she is home, next minute gone. lol, well almost. She went back earlier, so excited for the new unit, then realised she was back way too early and desperately homesick this time. She came back home, instead of toughing it out. She said she had a much better chance of not falling into depression or anxiety by coming back home. As always I observe everything she says and does. Sophie’s maturity surprises me to the level she has achieved (within a mere several months), her insight and empathy (so apparently missing) is finally blossoming. Doesn’t mean she was always calm and not hysterical at times, but a definite switch. Before she went back, the aspie side of Sophie was all organised. Doctor appointments made, counselling appt made, new referral appt with ED specialist made, classes sorted, disability needs sorted. She just ploughed through it all. This is the plus side of having aspergers.

The new ED specialist is more of a counsellor but has the insight and understanding of what having an eating disorder in your past means for you presently and how you relate and cope with life. Whilst Sophie has to travel to this centre, I am pleased she has taken this on board as an extra coping and learning tool.

It is also time to start weaning her anti-depressant medication. Five years is a long time to be on the medication, and now is the time to slowly (painfully slowly) wean her off and see how she responds.

For me it’s been a time of great reflection. 5.5 years into this, 5 years from diagnosis, 3.5 years from full weight stabilisation, 1-1.5 years with no anorexia behaviour or thoughts. It’s been an amazing ride, that only those who have been here know how crazy, mixed up, painful, the intense highs and the intense lows. Moving from small picture, every moment, every day stuff to big picture stuff that encompasses months. Being part of a new parent support group too, has been part of this reflection. I have had to think back to the very beginning, remember things I thought I had put away forever. It’s actually been a painful journey for me, but it has honed my thoughts and beliefs about eating disorders and taught me to be far more articulate and to advocate on a higher level.

Thought I would put together a summary – seems a timely thing really.

our anorexia journey

Biggest Mistake
* under estimating how long, painful and soul destroying this journey is
* feeling guilty that I had somehow caused this

Biggest Misunderstanding
* that we could get through this in a couple of months – not years

Biggest Regret
* not demanding more from the health system around us or challenging the wrong beliefs at the time

Biggest Fear
* wondering if at times I could continue to care for her
* her dying before we could turn this around into recovery

Biggest Lesson
* how quickly you go from health to critical and in a hospital bed
* how you can never never negotiate with an eating disorder
* your child is totally separate to the eating disorder behaviour
* comorbid illness are a part of eating disorders and make the struggle to recover harder and can become a part of life afterwards

Biggest Myth
* you don’t have to be skeletal to have anorexia
* relapse is a valid and normal part of recovery not something dangerous, fearful or not normal
* tube feeding is not a shame or psychological issue. Not now. Older women struggle with this and parents have their own hangups about this. The reality is very different for those in their teens who are tubed fed.

Biggest Support
* those I met going through this journey who were travelling it too
* having an amazing, strong, recovery focused team of five professionals

Biggest Surprise
* the inner eating disorder voice in my daughter’s mind. Like getting to know the devil himself.

Biggest Problem
* health professionals who still do not know how to diagnose or treat eating disorders
* the lack of resources (both money and treatment) for parents and sufferers to access to get treatment and recover.
* the different approach, government understanding and health systems in each country that actually hamper treatment when the illness itself is the same regardless of country.

What I did Right
* early detection, early intervention
* standing with her despite the horrors of the illness and behaviour and walking with her to recovery

What Benefits Did We Gain
* obviously my daughter’s life and health but also gaining a deep, close and open relationship with my daughter
* gaining some wonderful new friends who truly understood and still stand by us
* an intimate and highly experienced understanding and knowledge of eating disorders that we can share with others

What Did We Lose
* the years my daughter cannot get back of her normal growing up time with her peers
* friends

Before Anorexia
* my daughter was anxious, highly strung, a perfectionist, a misunderstood kid with her peers
* I thought I had a plan mapped out for some kind of normal existence like every other family raising teenage kids
* I thought I was already a strong mum because of domestic violence.

After Anorexia
* my daughter knows herself so well compared to other kids her age. Whilst this is a plus it is also a negative, as she struggles to find a close friend
* I learned I am stronger than I thought, I learned a deeper side of me, and I learned the dreams I had no longer ‘do it for me’. I search deeper.
* I am still finding who I am now, I no longer want the same dreams. I still struggle to find my way around a kitchen after so many years tied to anorexia cooking and preparation.

The Blog Role
* ended up being far more than I ever thought, and gained me so much privilege to talk to others on all levels in this journey. Thank you!

What would I do Differently
This is very personal. It would be to leave our dysfunctional family domestic violent life instead of waiting til further into recovery. I had planned to leave just before my daughter started down the slippery slope. I thought (wrongly) that staying might have been better for her health. It would have given full FBT a better chance and a safe environment that had no anger, expectations, eggshells etc in it.

Family Based Therapy
That eating disorder recovery is NOT a one-size fits all. Despite the best statistics, FBT (Maudsley, FEAST, FBT types) don’t always work for some families. This is not a point to be guilty about or feel like you have failed. It just is. Means you just go and find what does work for your family and how to care. As long as there is forward progress into recovery then you are going great with whatever you are doing.

Families are not to blame
I will keep saying this shouting it from everywhere. Eating disorders are genetic based. Families do not cause eating disorder and are not to blame for an ED developing.

Overall
My faith took a pounding, became far more realistic and more honest. Like David I adore but I will question and ask.

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Learning distraction techniques is part of the journey to recovery. It isn’t always possible to just ignore or shut out the voices. Sometimes you can work out what triggered the voice to be louder or more insistent and you can distance yourself from the trigger. But that’s not always possible. It is important if you can to at first acknowledge the voice, and try to work out what you were feeling just before it got loud, where you were, what happened etc. That can help you identify vulnerable situations for yourself and help you also learn more about you personally. But when the voice continues distraction techniques are the most important weapon you have. Sophie has been working through several worksheets her counsellor gave her, identifying what works for her, as well as a diary of what she does each time the voices get too loud. Sometimes she is dedicated to working on this and other times it gets shoved aside. Her distraction techniques only work as much as her commitment to the task.

Distraction techniques are not a magic wand, you have to be committed to using them and sticking them.

So what are distraction ideas. This is as unique as you are. It is a case of what works for you. CBT and mindfulness /meditation can help but you will need guidance and help from your counsellor to learn these. Others are as simple as:

  •  going for a walk, exercise, dancing
  • playing with your pet
  • sewing, drawing, painting, listening to music, writing
  • beauty treatments (nail polish, face masks, hair colour)getting outside and just moving
  • visiting, texting, ringing a friend
  • watching a movie or favourite TV shows
  • doing something very physical to get rid of anger, frustration etc (belt your pillow, throw a ball against a wall, use a punching bag)
  • cuddling your favourite stuffed toy
  • clean or re-organise your room

The list goes on. Pick and mix them up. Have a few you know work regardless. Try new things. As long as the moment passes and the voices fade. It can exhausting and be a real struggle to just find the energy to do the distraction techniques but it is worth it. The let down you get when you give into the ED voices is far worse.

For more ideas go to 151 things to do before you self-harm (I know a lot of you don’t self harm, but the ideas they give work for eating disorders, depression and lots of other mental health illnesses.

Another great handout, is the Alternatives to Self-Harm and Distraction Techniques pdf from Royal College of Psychiatrists. It is really worth getting. I have given this to Sophie – who actually seemed interested.

Talk through what works for you with your team, family or friend. Write it down so when you so don’t forget. When the voices get loud it can be really hard to think clearly and remember what you are meant to do. Just grab your written list.

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This post is two excerts from Weightless about the inner voice that is part of a lot of mental health illnesses and how to manage them. Worth reposting for my readers. I really like the bit about saying “Oh I’m hearing the critic now”. Sophie was taught to say “Oh it’s that anorexia voice again, it’ boring”. We learnt that pushing or arguing with the voice just adds more fuel to the fire. Taking away it’s power to hurt you by ignoring or downplaying it can be far more effective.

And yes the asperger post is next.

Distinguishing the Inner Critichttp://blogs.psychcentral.com/weightless/2014/10/how-to-distinguish-your-core-self-from-your-inner-critic/

  • It’s harsh and mean. If you’d never say these things to someone you love, it’s your inner critic.
  • It’s black and white. You are either beautiful or ugly. Your dreams are either possible or impossible.
  • It’s the voice of reason. It mentions things that are supposedly in your best interest, such as “If you go forward with the book, you’ll ruin your reputation. Your work isn’t ready for that level of scrutiny. Better hold off for a while.” I’ve realized that, today, my inner critic is largely made up of this voice. It’s the voice that says, Are you sure you should be the one writing this book? Can’t you think of 50 other writers who should be writing this book instead of you? You’re not very good at public speaking. Let’s never do that, OK?
  • It says, “you aren’t ready yet.” “You need more time to prepare,” or “You need more experience.”
  • It spews self-critical thoughts about aging or your weight, shape or size. It says that you look too big or too old. It says you need to lose weight or shouldn’t be wearing this or that.
  • It rehashes negative core narratives.
  • It attacks you with critical thoughts, and then shames you for having those thoughts.
  • It sounds like your parents, siblings or your boss or anyone else who’s been critical.
  • It sounds like your company or culture.

What to do when the Inner Critic is LOUDhttp://blogs.psychcentral.com/weightless/2014/10/what-to-do-when-your-inner-critic-is-roaring/

  • We never win an argument with our inner critics.
  • Instead, when we hear self-doubt,  name the inner critic: “Oh, I’m hearing the critic now.”
  • Explore the inner critic’s motives. We can ask: “What are you trying to do? What are you trying to prevent or protect me from?”
  • Tell the inner critic in a sincere way: “Thanks, but I’ve got this one covered.”
  • Separate yourself from the inner critic. Instead of saying “I’m having a freak-out right now,” say “My inner critic is having a little freak-out right now.” This helps to train our minds to realize that the inner critic is just one voice within us, and “not the primary one.”
  • Seek out humor. Ask yourself, “What is absurd or funny about what my critic is saying right now?”
  • Pretend that you’re putting all the inner critic’s thoughts away into a cup, box or bowl. Then move it into another room. Get back to whatever you are doing knowing that the inner critic is no longer present.
  • Notice where the inner critic’s voice resides in or around your body. Then picture that voice withdrawing, or moving away from you.
  • Picture a volume dial for the inner critic. Simply turn it down.

One thing she does miss in the ‘what to do’ is using your distractions toolbox. Friends, movie, doing something different or active can be like changing the channel on the TV. Removes you from the place where the inner voice was trying to get attention.

The inner critic

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slippery slope of anorexiaWe have been down to visit Sophie – my half semester visit to check she is going ok and to help with homesickness.

When she was home in July, I blogged how she had lost weight. Not in any danger zone, but certainly dropped a size. I hoped this was just her adjusting and her normal body shape and weight sorting itself out.

First impression when we saw Soph two weeks ago – “shit, she lost a lot of weight”. Dropped another size. Now there is NO room for movement in her weight. Loss of weight from here is the start of the slippery slope.

The complication is the trigger weight is not known. We used to know what weight would trigger the brain into full anorexic behaviour and make it difficult to pull Sophie out. Because of height, muscle and body changes during recovery and getting older, we don’t know what weight will start the trigger.

She had a good talk to me (whilst walking around the Victoria Markets). Makes it less intense for her this way. She admitted to having the voice back in her head and having to fight it. She admitted to having fear foods again and balking at eating them (or just not). The voice isn’t just telling her not to eat, but that she is a loner, is weird, no one likes her, she isn’t good at art – the whole sad, sorry and destructive stuff the anorexia does.

What can I say when I am so far away? Basically not a lot, except let her know I am her support and can listen. But I can’t make her eat and my encouragement is all I can give. I can only advise her to see her counsellor (thankfully she has done this twice since we left). What gets me most is that Sophie can see this happening to herself. She doesn’t want it to, doesn’t want to go back into anorexia land. But finds it so hard to fight back and gain back control from the voice. So easy for the anorexia to slip back in.

What made it turn up again? Nothing really. The internal issues she has, have surfaced more and she needs to deal with them. These are the same issues as before but she really has never broken free and forward progress seems to be very slow over time. Maybe the issues she sees are something she cannot solve as they are her character and personality. She misses home, misses my foundation support but also knows she has to stand on her own feet and fight this herself. The weight loss from sickness and not eating as well as she could, is probably the main trigger. Normal life just doesn’t happen in many respects for those in recovery from an ED. You always have to watch your health, stress, eating habits. It can be so easy to start falling down the slope again.

Supporting someone from a distance is tricky. Sophie is paranoid and super sensitive at the moment (all anorexia traits). She asks for advice and then tells me I don’t get it or understand. She dumps her emotions and then hangs up. The ‘fix’ she wants I cannot provide. The answers lie within her but she can’t or won’t face them. Supporting someone in an intensive uni course is also very difficult. The distraction tool box she has is based on her having free time to do some of the activities or take a break. When you are studying full time (5 subjects a semester and art being far more time intensive than essay writing) where do you find time to delve into the distraction box. We talked about this last night but it needs more exploration.

Whever this goes, we do it together. Praying and hoping the slippery slope doesn’t happen.

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This was going around Tumblr in the last few weeks. It encouraged me and reminded me of how important this is. What really spoke to me was the things listed. They weren’t huge goals. They weren’t nirvana situations. They were, instead, everyday little things. Grateful things, appreciative things. Things that you could instantly relate to and could achieve.

It is a very good idea and one that focuses you on the present and the future. Far too much of recovery is spent looking back, being caught in the past memories, past behaviours and fighting (exhaustingly and daily) the past. This is the nature of the ED illness and it wants to keep you looking back. It’s all about positive thinking as opposed to negative thinking. Let’s face it, ED’s are all about negative thinking so the more you can find things that help you learn to be positive is essential.

Recovery is about the present and the future. It is new not old and often it isn’t celebrated enough. Nor is enough notice or appreciation given for the small but critical moves forward. Even your therapist can brush over your achievements and focus back on old and past behaviours. Sometimes you just need a session that celebrates your moves forward, what you next move forward could be, how you feel about that.

Some of Sophie’s best good things about recovery were the small things. How good it is to eat strawberries again, how great it was to have her hair not fall out, how lovely it was to feel warm, how good food tasted, how wonderful it was to have people around her that helped her fight.

Other’s were big things: to be back at school, to be able to study, to not have weekly appointments, to have a life and future again.

Her celebrations helped to keep her focussed on the present and the future. Helped her fight back against the anorexic voice in her head. It wasn’t easy and many times the voice was stronger. But by writing down her ‘good things’ she could read them and remind herself any time she needed. Her mind was full enough with her voice, anorexic voice, therapist voices, family voices etc. By writing them down she could always cut across the voices and get out of her overwhelmed mind.

So the challenge for my readers this week is the same (if you struggle to find five, find three):

List 5 good things about recovery

 

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“Learn to separate yourself from the eating disorder”

Heard that yet from your therapist? If you are in very early recovery you are not going to understand what they mean. You and the eating disorder are still very much one unit. Are psychiatrist used this image to help Sophie understand.

  • Cover one hand with the other: that’s you and the eating disorder at the beginning. The ED is totally controlling you.
  • Then slowly, gradually start to move the hands apart: As you recover and learn more, you can start to see two separate entities, yourself and the ED.
  • Finally, your two hands are far apart: you are no longer controlled by the ED, you are your own person.

Both carers and sufferers must learn this separation technique. It is critical for recovery. It removes the blame and the idea the person is the problem. It shows that the eating disorder is a separate voice and thinking pattern to you. The eating disorder is the problem, never ever the person.

One of the best ways of becoming aware of the ED and how it is separate to you, is to learn to externalise the eating disorder. Like it is a separate being. It also empowers you to be able to make positive changes and think encouraging thoughts. It disempowers the eating disorder and the control is has on your life.

1. Give it a name

This may sound weird, but it does work. Give the ED a name. Ana, Mia, Ed, anything. This makes the illness separate to you. You address the illness. You see it as a separate entity to yourself. This gives some distance and makes the illness objective rather than personal.

2. You are not a label (or a victim)

Don’t call yourself or others the ‘anorexic’ or  the ‘bulimic’. Doing this ignores the sufferer as a person. They become a label or statistic. You are a person with a mental health illness called anorexia. All the things that made you unique as a person before this illness are still there and still real. The idea that you are a victim, also removes your power as a person. The word makes you feel you are unable to take control of your own life.

3. You still have a voice

It’s just silenced. That’s what the ED does. Learning to exercise your voice and make it strong again, gives you back the control. Just because all you hear at the moment is the loud, negative and destructive ED voice, that that is all there is. Your voice is still there, underneath, and can be developed to be stronger than the ED voice.

4. Make third party statements

When you don’t eat your scheduled meals, or you choose ED behaviour ask questions that don’t point the finger at you.

  • How did the eating disorder make you skip lunch?
  • What did Ana tell you today about yourself?
  • That’s the eating disorder voice I hear, what does (your name) think or feel?
  • Who made that statement, you or Ana?

5. Notice your vulnerable triggers and times

Eating disorders use certain ‘weak’ points, situations, times of the day, certain people to trip you up. ED behaviour and slip-ups are always stronger at these times. Being aware and forewarned can help you beat the ED at it’s own game.

6. Don’t beat yourself up

When you find it too exhausting or too hard to separate from the ED and you just let the ED do it’s thing, be gentle on yourself. It takes a lot of time and learning to get the separation/externalisation happening. You have lived for so long with the ED being often the only voice in your head. Your own voice is rusty from dis-use and like any unused item, takes a while to work.

7. Believe

Yes, externalising the ED is possible. It is a real thing and can happen for anyone and everyone. But it’s not a magic pill or wand. It needs commitment and skills but achieving this is a major step forward in recovery. It opens your eyes to the real character of the eating disorder and it shows you the beauty of your own voice. Therapy with a skilled professional really helps with learning this process.

 

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self-sabotage and eating disordersTo those who don’t have a mental health illness, the idea of actually sabotaging your own recovery is just illogical. I mean, really, why would you do that.

There is very little that is logical in the thought pattern of someone with a mental health illness. Because of all the other thought patterns, learned behaviours, voices etc, logic and rationality don’t always come through. Even with my depression, my self-sabotage is reflected in my not taking care of myself, not getting the right foods, enough sleep, enough time-out, etc. I know what benefits me, but don’t do it. And I know what the outcome will be.

Similarly those with eating disorders are ‘great’ at self-sabotage because of the controlling voice and the
underlying ‘I don’t deserve to recover or live’ belief.

It’s not an outright decision to sabotage but more a subtle, sub-conscience view of your recovery. The eating disorder voice uses this mental ability to the max. Like it LOVES it. Sneaky, manipulative, subtle, hidden messages – the ED will sabotage your recovery in any way it can.

  • Don’t follow your meal plan
  • Do Over-exercise
  • Do Harm yourself
  • Don’t take your medication or listen to medical advice
  • Make life choices that remove your ability to move forward

Tackling this voice and meeting it head-on with force and saying ‘no’ is very difficult and takes practice to learn. Don’t say it isn’t possible or you can’t ever imagine a stage where you could do that. Believe me, you can learn. The ED seems like it has a complete hold on you, but it doesn’t. A bit like a bully: continually challenging, pushing away and learning to use your new behaviours and toolbox, will crush the bully.

My son, with his anxiety disorder, actually deprived himself of sleep and created a ‘perfect storm’ environment to live in. A custom designed hell. Why? Because he felt he didn’t deserve to have a nice life, didn’t deserve to recover from his trauma.

ED sufferers move away from home too early, underneath knowing they will probably not be able to sustain the level of self-care to not let the ED get a stronghold again. They don’t put into place procedures and routines to help them live.

Instead of making good, informed decisions, you put your head in the sand and let life take you wherever. It might mean spending all your money so you have no rent money left, meaning you are forced to move home. Maybe you really wanted that and couldn’t ask for help, or maybe you felt that you didn’t deserve the freedom of life away from home.

My daughter used to allow life situations to over-run her and then deliberately fall into anorexia habits. She could then blame the situation and take all responsibility off herself and self-sabotage her recovery. She would knock herself down basically.

Not wanting to be held responsible for your recovery and to make the every moment decision to recover is a good reason for self-sabotage.

As long as you can blame someone or something else, or ignore deliberately the behaviours/routines you need to recover, you can sabotage your recovery for years.

I am NOT saying at all (please hear this) that you have full control over the ED. I know the voice controls you and I know that you don’t have a choice in how you react to life and yourself. BUT in later recovery, you have learnt what is needed both mentally and physically to sustain recovery. You have learnt that the ED is separate to you. Yes it’s exhausting and difficult to continually choose to recover, and I get that it is easier many times to just let the ED have it’s way and pick up the pieces later. The self-sabotage at this point of recovery is when you keep choosing to ignore your recovery program, when you choose to let the ED ‘win’ more often. I watched and talked to many girls (including Sophie) and you can tell, as she did, when she was allowing the ED to re-assert itself due to just exhaustion or it was a deliberate fall back into it because she didn’t follow her recovery program.

 

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