Mental Health: A reality check

03/02/2014 at 05:50 (Personal, Reviews, Writing Reality articles) (Anorexia, Blogging, education, Kick-Back, mental health, obsessive compulsive disorder, perspective, psychological, Review, Writing, Writing Reality)

We all have our own idiosyncrasies. As a child, I’d arrange toys in a system only I could navigate (so my bedroom resembled a bombsite), setting out scenes and narrating the stories of each “character”, while becoming quite agitated if anyone dared disrupt whatever master plan I had in mind.

On the flipside, it was incredibly difficult to concentrate at school. My grades suffered at the hands of a creative streak that made daydreaming a far more pleasant experience than learning times tables – as I’m sure many of you can empathize with. But it even spread to my favourite subject, English, with a lesson soon abandoned in favour of scribbled little half-stories that went nowhere, poems in paperback binders. Tippex’d quotes on tables. Consistency, adherence to anything, wasn’t a strong point.

Anorexia Nervosa changed this. Aged sixteen, I was fed up with the onslaught of change that had made up my teen years thus far, and was determined to take back control. This is a keyword. Everything was falling away – childhood (with puberty), family ties (my parents were going through an acrimonious divorce), the supportive structure of compulsory education – a huge factor in my life from age five, as I had travelled a good deal beforehand and was something of a late starter, particularly where reading was concerned. Coming back to the UK, settling into the routine of lessons and friendships, had provided a quieting influence.

Where the abuse was concerned, there was a different perpetrator for each incident. It got so that I began to believe I had the word VICTIM stamped on my forehead; that I was somehow sending out the wrong signals, whether by my gender, appearance or behaviour. I went to great lengths to make myself as unattractive as possible, while in a strange double-mindset, wishing to be attractive to the boys I liked with all the fervour of teen hormones. It was a razor-edge time.

Weight loss soon impaired my thought processes, and the little “tendencies” I’d always had, grew into frightening routines which – looking back now – I am stunned to consider were part of my daily existence. I could not go an hour, a minute without engaging in some “behaviour” or another – mostly exercise-related, for this was my “healthy” choice of weight loss. I figured it wouldn’t rot my teeth as with vomiting, or impair my gastric system as with laxative abuse. Coinciding with a decrease of all the “bad” foods in my life, what could possibly go wrong? I didn’t see the latter as starvation, and it certainly didn’t start out that way. It rarely does. It’s a gradual tipping point of Can’t Have This today, so Can’t Have It tomorrow, either. And so forth. All those little bits that get chipped off, soon add up.

Compliments from classmates and my family (not to mention the increased attention from boys in my year, a first) were all related to my weight loss, and seemed an affirmation that what I was doing was right. No matter that it secretly involved some truly odd behaviour, which I won’t list here, as I am ever-wary of triggering or influencing someone who is vulnerable. By losing weight, toning up with increased exercise and enhancing my new “feminine” image, I appeared to be making myself stronger, more in control.

The truth was the exact opposite. I had never felt more alone, and unlike myself. Rather than spending hours reading, I was straightening my long blonde hair to within an inch of its life. Where I used to be down the woods, climbing an oak to reach its zenith for a spectacular sunset view, I was out in the lamplight haven with several peers who I no longer have any contact with – we were joined by a single mindset of alcohol and smoking, escapism in sex and whatever soft drugs were going around. I barely recognised myself. But it seemed the “right” thing to do, as did the secret eating / exercise habits I kept up around all of this.

Anorexia will isolate its victim, locking them in ice and paring off that which is “superfluous” to its needs, and likely to get in the way of control. Emotions are kicked out, in favour of Obsessive Compulsive Disorder (OCD) routines, controlled eating / starvation habits, purging. I didn’t want the lives of others holding me back from the ultimate goal of losing weight, of becoming “pure” again, after all that had happened. This kind of selfishness is inherent of the illness.

When the world became too exhausting, I shut myself away in my mothers’ house, to play out the exhausting ream of routines. Exercise was consistent but unstructured; I didn’t get a gym pass until after hospital, and only then by my doctor’s notice. So it was an exercise free-for-all, of taking great pains (literally) to go the furthest distance wherever possible. No cutting corners, no sitting down, no taking the lift. If it could be walked, I’d walk it. No circumstance was too difficult, no weather too awful to go out in. If it meant more calories burnt, then more control could be taken back.

One very prevalent habit was the cleaning. I know many OCD sufferers will relate to this, with or without anorexia. I could not leave the house until it had been turned upside down and back again. Having military parents might have had something to do with this, too. Whenever someone dropped something – my brother, bless him, can’t eat without leaving a trail of bread crumbs any witch would be proud of – I would be on it before he’d had time to move away, sweeping up around his feet. My brother felt as though he was in the way, that simply being around was causing me stress. Though only 9 years old, he was (and is) a sensitive little soul, enough so that he went to great lengths to keep me “safe” as possible.

There are certain scenes I would erase from the back of his eyelids forever, if I could. Things that I myself can’t remember, having either burnt them from memory or from being too ill to form them as memories in the first place. Only my mothers’ input and my brother’s recollections have made me aware of their occurrence; such as the afternoon when the former came into our kitchen and found me standing with a meat knife in my hand, staring at the wall. They had been eating a Chinese takeaway dinner in the next room, and the smell was apparently of such torment to my aching senses that I simply stopped still, like a wound-down toy – but not before somehow getting hold of that knife, resting it in my palm, blade pointing to the carpet.

She took it from me, asked what I was doing, with that bewildered / angry despair that was her customary state in those darkest days.
I shrugged. Didn’t say a word, for how could I tell her that my feet hurt so much from pacing? She would only make me sit down, and that was a worse terror – to rest, to “gain weight.” So I stood still, counting heartbeats and blanking out the delicious smells from the lounge, the sound of my brother’s precious laughter.

I still thank Whoever that he didn’t see me like that, at least. But my mother did, and threw me a disgusted look.
“If you’re going to kill yourself, just get it over with,” she snapped, before stalking back into the lounge and closing the door.
Truly, there is no way to describe how I felt from hearing those words, and having the knowledge that I had caused her to
say them. I hurt her so badly, and this is something I will never forgive myself for, no matter how much else I have reconciled as part of the recovery process. I might as well have stabbed myself in the chest, for the pain that nested there. As it did some years later, when my brother – then fifteen – was listening to Eva Cassidy’s Fields of Gold with me. I was (cautiously) en route to becoming well by then. He put his head on one side, looking thoughtful.

“I remember you sitting in the dark listening to this,” he said matter-of-factly. “You said it was the song you wanted to have played at your funeral.”

My mind went pale.
What kind of older sister tells her little brother this? The very fact I have no recollection of it happening, of the words that would stay with him forever, is testament to how ill I had been at that point. Anorexia had done its work.

On the 20th of January this year, Deputy Prime Minister Nick Clegg spoke at a conference in London, which brought together experts in mental health, associative charities and users of mental health services, to talk about how treatment can be improved across the country. He made it clear that public attitudes and social opinions must change.

“Today we’re calling for action – across the NHS, the mental health sector and wider society – to champion change, to transform outdated attitudes and practices and to improve the lives of people with mental health problems.”

Outdated attitudes such as England cricketer Jonathan Trott being told to “pull himself together”, perhaps – that “winners don’t quit.” Or indeed, telling someone who has Binge Eating Disorder that you “know a diet that is really effective; I have the book if you want it.”

Society tends to base its assumptions on what is tangible. A broken arm is cooed over, the cast is signed, time off work is granted if necessary or lighter duties permitted. Condolences are doled out because we can understand physical injuries / impairment based upon what we have experienced ourselves. Everything has a relative link to something else; though I haven’t broken a bone in my body (as yet) I know all too well the pain of a puffed-up sprained ankle, and the boring slog of keeping it still so that recovery can take place.

Physical pain is easier to identify with, I believe, because even an old injury can have painkillers thrown at it, a supportive bandage put on, perhaps some deep-heat lotion applied to take the ache away. Time-consuming perhaps, but not nearly as much as sitting down with that pain, talking to it and teasing out its problems; using the Hot Cross Bun model of Cognitive Behavioural Therapy to cut through the emotional cause = reaction cycle.

Following inpatient treatment, I was discharged back into the world, to make of it what I could with all that I had learned. Funding for the halfway-house where I was supposed to continue treatment – as a means of reintroducing me to the world and independence – had fallen through. I remember hearing similar cases of this while on the ward, and being alarmed at the regularity of its occurrence. Deemed a healthy weight for my height and age, I had been out of “normal life” for seven and a half months; though if you want to look at it on a broader spectrum of experience, I had been “out of it” for years. So to still be lumbered with the thoughts and emotions I had been admitted with, seemed a harsh laugh in the face of all the time spent inside. It didn’t take long for me to relapse.

I was nineteen years old, and felt utterly worthless. I had no job, and only marginal experience of full-time employment before inpatient admittance. Due to leaving sixth form early, I had no further qualifications than GCSE level, while many of my peers were by that point already at University. I survived on Disability Living Allowance – the lower bracket, since I was means-tested and found to be mobile enough that I did not require a higher level of benefits. In some ways, this was true, though my bones were fragile and my skeletal muscles were pretty much non-existent. Blood tests every fortnight showed that inherent low glycogen levels (hypoglycemia) would be an enduring problem, particularly if exacerbated by poor nutrition and liver breakdown when very underweight.

My mother could only earn so much to sustain us both – especially as I was already back on a build-up plan. Naturally, I wanted to live off low-calorie “health” foods, and walk/run all over the place. Old habits soon crept in, without the support of the dear friends I’d made on the ward, or the firm eyes of the staff. The arguments with my mother were formed of a tired desperation at having to rehash old subjects again and again (a carer of someone with an eating disorder may know what I mean), and a very real fear that I’d go into a coma. Christmas Eve, my GP rang to tell me that, after checking my last batch of bloods, I wasn’t to move an inch over the holidays.
I laughed down the phone at him.

Looking back, I shudder at my own naivety and subjection to anorexia’s iron grip. I simply couldn’t comprehend how much danger I was in. By that point, I was almost back to the weight I had been pre-hospital – a madness of thoughts, like crows circling in the lowlight:

Have I eaten too much? when can I eat next? how can I take the hunger away? when can I exercise next? have I burnt enough calories off? did I do this right? is anyone watching?
*God I feel like such an idiot. People are watching. They think I’m weird. I never fit in anywhere. Fuck it, might as well continue*

There are always snippets of the Self, shoved up against the side of the brain; the little whimpering voice that pleads to basic principles and beliefs, such as Love and Awareness and Giving a Shit about other’s Feelings. Never quite loud enough to overcome the white noise, which only gets more distorted and violent in pitch the further down you go. It really is like someone adjusting an aerial or dialling the frequency on a radio, losing the presenter’s voice among the fuzz.

Since I couldn’t yet face full-time employment but was determined to stay out of hospital, I went in the opposite direction and enrolled back in college. Having left sixth form early, to be cared for by my Nanna before entering inpatient treatment, I was three years behind my peers in terms of what the majority of them saw as a natural progression – further education, university, maybe a gap year between. I found myself a late starter in October 2004, back in my old college and in the sixth form block, where I’d seen the tall lanky teens come and go in their Levellers t-shirts, skanky jeans and Avril Lavigne makeup. And that was just the ones I paid attention to, the “alternative” crowd.

Incidentally, I can’t stand stereotypes, and will bristle whenever someone slaps this label on me. Alternative to what? Life?

Now I was to take their place, but felt incredibly small and insignificant by comparison. The block wasn’t the shining shrine we’d always imagined it to be, full of gleaming vending machines that we uniformed kids were banned access to, and comfortable with stuffed couches in the lounge. It was small, and stank of BO and someone’s dad’s aftershave; the vending machines needed a kick just to get them to light up, and the couches haemorrhaged their stuffing with every tatty-jeaned backside that flopped into them. Mind you, the wrestling matches didn’t help either.

It was loud and bristling with hormones; bright with Punky Fish a-line hoodies, beanies and those bloody awful punk-ballerina skirts that were the rage at the time (Avril, you have a lot to answer for.)

Sixth form seemed at first worlds away from the inpatient ward – raucous and fervent with the fast-approaching future, an extension of the playground rituals and classroom laws of childhood. But after a month or so of watching my younger classmates, I realized how uncannily alike we were, despite their optimism and the age gap. Here too were the crossed-wires of hormones, the mood swings, the searching for identity, which can beset a recovering anorexic and leave them so utterly confused as to where they stand, how far away death might be in relation to life. Listening to their talk, absorbing it all, I didn’t feel quite so alone. Though it took a good few weeks before I’d dare to open and talk to any of them.

Despite maintaining a low body weight, I still felt emotions (much to my annoyance), and desperately tried to cancel these out by visiting the gym next door as often as possible. All this did was tire me out so that my grades began to suffer – and what a novel concept it was, to realize that something other than weight loss actually mattered. I wanted to do well, to overcome the memory of the balls-up that was my GCSE’s. So, with the patient help of my teachers and Form tutor (all of whom were aware of my condition, and went to great lengths to make sure I had avenues of help in the school nurse, or just a listening ear) I flung myself into studying. Nothing is ever worth doing by halves.

Anorexia was by this point sitting back on its sharp haunches and looking around in confusion:
What? She doesn’t want me around anymore? What’s going on? We’re still terrified, here.
As it tightened the noose, trying to claw back, I became silently abhorrent in behaviour – perhaps more so than before hospital, for now I had the driving force of exams up ahead. Racing towards the finishing line, though in all honesty, I had no thought for what lay beyond. University still seemed a distant dream. I just had to get through A Levels, first.

In appearance, I was all right-angles and hunted eyes. Incredibly defensive, walking with a strut that belied the cower beneath, with cropped, multicoloured hair that made up yet more jagged lines. I didn’t see this for myself, except in photos. These acted as a conduit between what anorexia showed me in the mirror, and what others perceived. This still holds true today.

It didn’t take long for me to gain the reputation of a loner. I was mingling with the younger brothers and sisters of my old classmates – a weird enough situation, without the fact I still had to carry food-packs around with me all over the place, just to stay upright. We were allowed to eat in class, within reason, but public eating will always be a wary subject for me. Still, I had to maintain my weight, and to do so meant eating very regularly. I was allowed to sit at the back of every class, so as not to draw attention to myself. I could leave whenever I wished, and would often do so before the bell rang, just to make sure I could gain access to a certain treadmill in the gym. OCD dictated that I had to use this particular machine, and I’d be fiercely agitated if it wasn’t available.

The strong support system allowed me to progress, both in health and education. At any one time, I could speak to a counsellor or teacher, and have them liaise with my local NHS care team. This is essential for stabilizing a child / adolescent’s sense of security – they must feel as though they are being heard, that their health issues are not being ignored, while maintaining the delicate balance with continued education. While an inpatient at Bethlem Hospital, I observed several younger patients attending the Bethlem and Maudsley Hospital School, which provides education for child / adolescent inpatients. This prevents students from falling behind, while keeping in touch with the outside world – an essential feature of regaining physical and mental health, without becoming institutionalized.

For all the support and sympathy of the adults, there were several kids in my college who would have benefited from increased awareness of mental health issues, and subsequent care. About four months into my first year, a small group of lads – all still in uniform – took to following me around the campus and sometimes through town too, calling out “Annie Anorexic” while giggling into their hands. The humiliation of this was, I can assure you, quite exquisite. I was already exhausted from juggling anorexia, OCD, education and part-time work. Retreating into myself, I ignored them and beat out frustration in the gym.

When this no longer sufficed, and I was found sobbing in the girls’ toilets one afternoon, it was reported to the head of sixth form. A man of the old-school style, he scared the Hell out of me (and most of my peers, plus several younger teachers) when I was in uniform. By that point though, he had become a good friend. I will never forget that afternoon when he put aside his entire hectic schedule, to sit and talk me through all that had happened – not just the teasing, but everything, dating right back to when I had been his student in compulsory education.

I wasn’t present to see the dressing-down each of the boys got, nor did I wish to receive a personal apology from any of them. What I was gratified to note were the measures immediately put into place to prevent the bullying from spreading further. Turns out I wasn’t the only one being wound up. An assembly was called for the benefit of the school, with information made available about mental health awareness, and relative care / support systems. I’d like to think that it caused several others to come forward, who might have been hiding in silence.

When summer 2006 rolled around, I was still stuck in a mental rut where health was concerned, but had somehow managed to soak up an education. My weight had remained static for two years – a real achievement. The routines that seem so dull to me now, agonizing in their meticulousness, had kept me in a safe status quo that allowed me to dial down my thoughts for studying. It’s the equivalent of turning your phone off or putting it on silent before a meeting or writing session. But while anorexia wouldn’t allow my emotions or those of others to filter back in, with education, I could at least put the book down and walk outside again. It became easier to do so. I had reasons to leave the house.

I owe all of my teachers a great deal, for allowing me silence when I couldn’t find a word to say, and listening when I chose to speak up. It was as though college had become an extension of hospital; a place where I could find courage enough to regain trust in my opinions and beliefs, and the voice to express them. For years, I would laugh at people who applauded my efforts – this now seems an ugly, ungrateful thing to do. I will try to be gracious wherever possible.

I must admit, I did cry a bit while accepting a hug from each of my teachers, when the exam results came through. I’d not only made it into the top set with all three subjects – English Literature, Language and Film Studies – but top of the regional sixth form tables. It made the local paper …which I didn’t keep a copy of, because I didn’t think anyone would really care, or that it was worth keeping around.

Some old habits die hard.

Clegg has made his stance on mental health awareness / treatment known, while Leader of the Opposition Ed Miliband is backing the YoungMinds Vs campaign, stating that their “survey exposes some of the pressures children are under in Britain today, from bullying and sexualisation to worries about job prospects. And when they feel depressed, too many young people are afraid to speak out or find a lack of support when they do… Mental health is the biggest unaddressed health challenge of our age, and young people’s mental health must be a top priority for Britain.”

Personally, I could care less which party oversees an improvement to the overstretched mental health services across the country, so long as it is sustainable and not a flash-in-the-pan. Mental health awareness is here to stay. Actions over words, as ever.

Where my own mental health is concerned, it is still one day at a time. I can laugh at things that would once have set me back; but this is through my own progression, over a matter of years. Others, I know, have not been so fortunate.
I keep them in mind, even while walking forward.