Fully Recovered, but Not Quite: The Long Post-Anorexic Road

About a year ago I wrote a post which outlined my ambitions for continuing the process of recovery from anorexia. I want here - nearly three years after my recovery began - to assess how fully I've managed to address the things which it then seemed crucial to come to terms with, and to ask whether any new obstacles have emerged between me and a physical state and way of life that feels not just post-anorexic (i.e. still partially anorexic) but healthy and no longer too much defined by the past.

The four main issues I flagged up this time last year as problematic for me were:

1. I knew I needed still to learn how to work less, and achieve a better balance between ‘work' and ‘life'. This is something I also addressed in last month's post, less in the sense of my parents' possible influence (which was what I focused on a year ago) than in the practical senses of truly valuing other things, and truly recognising the detrimental effects of post-anorexic (still semi-anorexic) thought and behaviour not only on ‘life' but also on work itself. More generally, I asked a year ago how the sense of a need to be extraordinary (however illusory anorexia's response to that need) could be relinquished, or at least transposed into something more positive.

2. I needed to get used to my new, non-anorexic body, and the possibility that it could be attractive because, not in spite of, its solidity and lack of ‘uniqueness' in thinness.

3. I felt intermittently crippled by self-loathing for past (anorexic) actions and current ones: for how much they had hurt or continued to hurt other people; for my perceived selfishness in both illness and recovery. I felt paralysed, too, by the inability to judge the degree to which such selfishness was an acceptable feature of recovery just as it had been an inevitable aspect of anorexia.

4. I experienced spells of emotional blankness during which I was unable to love, hate, or care about anything, and which frightened me through the intensity with which they could distance me from everything that normally mattered to me.

Which of these still apply?

To start with, the simplest: I haven't felt the emotional flatness for a long time now - more than six months, I think. I still occasionally get overcome by what feels like depression, or a sort of anger which I'm unable to articulate - but the causes of such states are generally quite clear (returning from holiday, or having an argument), even if their vehemence does point to a lasting emotional fragility. Maybe those earlier periods of total dissociation - lasting between minutes and hours - were still residual effects of the emotional readjustment that was necessary after prolonged starvation. (See Harrison et al. [2009] on problems with emotional recognition and regulation in people with anorexia.)

The self-loathing has diminished almost to the point of disappearing too. I'm still not terribly good at being lenient or forgiving with myself, so that a single mistake - an incorrect reference in an article I've sent off, most recently - can plague me for hours and days (as I'll expand on in a moment, this is a part of more generalised anxiety). Socially, I still come home from seminars or dinnertime discussions worried that I've argued too intensely or not been attentive enough; but this doesn't generally spiral into a conviction of my own worthlessness or wickedness. I don't any more find that I hate myself, and guilt about the past has simply diminished with the time that passes during which I'm kinder to others, and can make them happy rather than only ever sad or angry. I still feel bad about some friendships which ended when my illness did, for varying reasons, and I intend to resolve that guilt in some way when I can. But the longer I live without anorexia, the more completely I understand that I am a fundamentally different person from the ill me, and that relationships which worked for her and the other person will not necessarily work for either of us now - or perhaps even that relationships which worked then are positively unlikely to work now.

This knowledge can create difficulties of its own when it comes to interacting with the people who must necessarily remain close to me: my family. With some of my relatives more than others, I am aware that the Emily they are most used to engaging with is the one who no longer exists, and that there's still work to be done on both sides to find new replacements for the outdated ways of talking, listening, and accommodating that are still the default. Some of the old ways still haunt me, especially in my mother's house, which was bought shortly before my recovery began: at a party there, if I'm feeling shy, I might be transported back to the days when I'd linger awkwardly on the edges, upsetting anyone who noticed me, waiting for everyone to finally go home or to bed so that I could begin the long hours of tidying up and then, finally, start to eat. Nonetheless, I know that these memories will gradually lose their capacity to cause me pain, the more days and months I live in a way unshadowed by the reality they bring back.

My body image has gradually improved over the past twelve months. Strength training has helped with this, turning my body from something merely aesthetic to something which can be beautiful in its functionality. I still sometimes see photos of myself, or try on dresses, in which I think I look fat. But this happens quite rarely, and in the real life of catching glimpses of myself in mirrors or windows, of getting dressed in the mornings, of using my body to lift weights in the gym and walk and carry things, of feeling and responding to its needs in hunger and thirst and sleep (of which I continue to need prodigious amounts), it's now simply what I am, and I am proud of it. I am proud not to be thin; proud to have the physical strength to squat twice my former bodyweight; proud that I no longer feel any need to prove something to myself or others by resisting eating. The sight of very thin girls and women in the street will perhaps always upset me, always take me back briefly to the time when I was like them, but perhaps not always make me quickly assess whether or not they're thinner than I used to be - that last response is growing weaker now. I threw away masses of old tops and skirts and dresses at the weekend, most of them because they no longer fit, and I don't mind at all, because the things that still do fit do so properly. I fill them, and they no longer hang off me.

As for the question of ordinariness: in both the mental and the physical sphere, I've realised that I don't know what it would mean to be ordinary. No one feels ordinary from the inside, and no one else's external judgement of oneself as ‘ordinary' (though who goes around making such judgements?) has any validity. I certainly don't feel more ‘ordinary' now than I did when there was 30 kilos less of me. I feel strong, contented, alert, stable, more patient than I used to - all sorts of things, but not ordinary. I don't feel any more that I need an external warning signal of my fragility or alienation from the world, because I no longer feel either fragile or alienated. Anorexia, and starvation, perpetuate the problem to which they are the supposed solution in that regard: I must let people know how weak I am, so they'll make allowances for me or just leave me alone, but in doing so I make myself ever weaker.

On a weekend away in Scotland last month

Source: Sue Blackmore, used with permission

And as for the final thread from last year: I have at last learned how not to work all the time, and how not even to want to do so. In fact I never wanted only to work, I think; I just didn't know what else I wanted. A really magic phase in this development was our holiday in Corfu last September: ten days in which I sunbathed, read novels, swam, ate, drank, and wanted those days to last forever. Not a practicable recipe for everyday life, perhaps, but confirmation of the fact that I was no longer an academic thought-spewing machine (my boyfriend's phrase), but a sensory embodied being who loves sunshine and nourishment and indolence just like a cat or some other creature less self-deceptive than the human being can so often be. Since then, embarking on a new research project, I've worked less long hours, worked not at all at weekends, enjoyed a week's skiing and various other breaks, and despite some flashes of guilt at not working enough, I've if anything experienced the opposite problem, if problem it is: rather than taking for granted that academic pursuits are all I want for my future, I've now had to question that assumption, question whether I actually care enough about what I'm doing to continue to expose myself to the potentially pernicious aspects of the academic atmosphere. Perhaps in the end my answer will be yes, but even if it is, it will have been a question worth asking of myself, with a real conviction that there are other options, and that I am not just the sum of my academic thoughts.

Anorexia Nervosa Essential Reads

Anorexia Nervosa and Superior Mesenteric Artery Syndrome

Anorexia Nervosa: Addressing the Bugs in the System

Nonetheless, not working is in some senses still difficult for me. When I'm not working (and not lying on a Greek beach), I'm watching DVDs or reading, or walking with my boyfriend, or going out to dinner with him, or for drinks with colleagues; I still have no hobbies (except the lifting), and few friends. My ability to stop working and do other things depends to a large degree, I think, on my partner: without him to eat, talk, laugh, go out with, go away for the weekend with, I simply don't know how easy I might find it not to bother, or how easily I might succumb to the pressures of my professional environment. I've discussed recently the ways in which academia may both heighten perfectionist anxieties and make certain personal needs, like plenty of time not working, difficult to defend to oneself as legitimate. Perhaps it's true of most people in long-term relationships that their lifestyle and happiness is dependent to a large extent on the presence of the other person, but most people do, probably, have more going on that's independent of the relationship, and this is something I need to make true for myself.

This is a remnant of anorexia, I think, as well as of the character which was susceptible to anorexia in the first place, and exacerbated by it. Obsessively self-demanding and perfectionist habits create the ideal environment for an eating disorder, as compulsive controlling mechanisms are transferred to the realm of food, making it into a reward for achievement. Then the physiological effects of malnutrition tighten the grip of such habits, by inducing repetitive cycles of thought and behaviour that are manifested in ritualised preparation and consumption of food, in obsessive-compulsive rituals more generally, and in disproportionate attribution of importance to all sorts of tasks and values. Neither the centrality of work nor the other relic, anxiety, has anything to do with food anymore, but they can nonetheless be seen as part of the aftermath of long starvation, which makes food all that really matters, but, in the long hours without food, also makes the tiniest thing matter unbearably.

Anxiety, or perfectionism, or a mixture of the two, is the worst legacy of my anorexia. There's very nearly always something niggling, worrying away at me, regarding a past failure. I tend not, as seems common from the anxiety self-help books I've consulted, to worry about future events; but as soon as something is in the past, unchangeable, it can become a little torture instrument to turn calm into the quiet distress of being unable to rest, mentally, but keep turning over the same mistake, real or imagined or blown up out of all proportion. This isn't to say that things haven't improved dramatically since the days of my illness. Then, the fear wasn't only retrospective: I'd spend a whole cold night adding more text to an already massively overlong thesis chapter, feverishly weaving a convoluted conclusion together out of the 35,000 words over which I had no overview, unable to eat before it was done, but unable to think properly without food, sustaining myself with cup after cup of coffee or low-cal fruit squash, colder and colder and tireder and tireder but above all scared of failure.

Now I've learned to be calm, mostly, before the fact (though I do spend too long making emails perfect, postpone sending off an article because I'm scared of the anxious aftermath), and deeply resent the sneaky little barbs of condemnation that creep in afterwards. I know that I tend to try to block them out, submerge them, in order to be able to drop off to sleep or enjoy something fully, and that that can only ever be a temporary solution. I know it's much better to confront them head-on and see what it is they're actually wanting me to believe about myself - that I'm a careless, lazy, untrustworthy, or socially inept person - and then to challenge that judgement. But often I don't have the strength or courage to do that, or don't want even to grace these sneaky intruders with that much attention.

Another useful strategy I've found is a variation on something my therapist suggested to me: she asked me to engage in ‘exposure therapy' by deliberately making ‘mistakes' (misspelling things in emails, leaving a cheque unsigned) and seeing what happens, and how I'm capable of dealing with it. I now find it quite helpful to pretend to myself after the fact that my mistake was deliberate, and treat the consequences as an experiment in how little people actually care, or notice, or how everything can be coped with. Perhaps, though, I need to find some lasting way of freeing myself from this sort of torment; I'm not sure it's going to be enough to wait for this to fade with time, as so many other anorexic relics have done.

As I wondered already a year ago, I don't quite know how legitimate it is at this point to say: this far and no further. I've come so far, I've expanded my comfort zone so much beyond its former tiny perimeter, that perhaps it's all right now just to want to live, and not keep improving myself, keep furthering my recovery. But then, it is contained within a comfort zone, the life which I currently lead; and it's not just myself that I might seek to improve and expand further, but that life itself.

I want it to be a calm, happy life, without guilt and without perfectionist torments; I want it to be varied, and open to unknown variations, on a grander scale than now. Now that no one could tell from the outside that there was ever anything really wrong with me, I want all negative mental and behavioural traces of that past to be conquerable. Perhaps this is impossible: perhaps the price of the wisdom anorexia did give me is these few lasting afflictions. But perhaps not - and there's only one way to find out.

I'll let you know.