Not Skinny Enough... For Eating Disorder Treatment

 It's been a while. I'll get into why in a later post, but for now I need to get this off my chest. I will be talking about Eating Disorders and Mental Health. It will be very angry, very sweary and very raw; so if you don't feel up to reading about these topics then that's totally okay, I understand 💙 

 I had a phone call from my CPN today, I've not seen her in a while because I've barely left Heaton in the past six weeks. Other than Download Festival - a break I desperately needed - the furthest I've been from home is to see my parents. My CPN is based in Gateshead and is in the process of switching me over to the Newcastle team for the rest of my treatment; Gateshead are frantically trying to reduce their case and patient loads, my guess being because of budget cuts and staff shortages, and Newcastle have better resources for helping patients with Eating Disorders. It sounded like a sweet deal, closer to home and more specialised treatment than just DBT, and they had no waiting lists so I could be transferred straight over. However that phone call shattered any illusions I had about finally getting back into recovery.

 I don't blame my CPN, she was trying to get me more specialised treatment closer to home - exactly what NICE guidelines specify as key criteria for successful recovery - and even now she's writing letters and making more calls to try and change their minds, I'm very grateful for her. I have lived with an Eating Disorder in some form or another since I was 14, beginning after I was sexually assaulted; at some point over the years the bulimia developed into anorexia, though the binging and purging still like to rear their ugly heads from time to time. I consume on average 700-800 calories per day. I have a BMI of 15.8 (though BMI is bullshit criteria anyway). I've lost over 10kg since the beginning of 2018. I have collapsed in public due to sheer exhaustion. My thoughts are clouded, my brain is foggy and my periods have virtually stopped. But according to Newcastle's Mental Health team? I'm "not underweight enough" to receive treatment.

 They always say that asking for help is the hardest step to make when you're trying to recover. I asked for help in 2015, I saw my GP in Gateshead, got onto the waiting list for a psychiatric evaluation and four months later was diagnosed with a personality disorder - because nothing makes you feel more fucked up than being told it's your personality that's the problem. They never explored this, never worked on giving me anything more specific, just sort of went from there and offered me different types of treatment, from one-to-one talking therapy, mindfulness exercises, more DBT - including group therapy. Apparently this was part of the problem for Newcastle, as it wasn't until later into my treatment with Gateshead that I was recognised as having an Eating Disorder, they didn't see it as a long-term problem because of the late diagnosis. 

 They also said I seem "unwilling to accept treatment" too, based on the fact that I dropped out of the DBT group therapy after a few sessions, and refused an appointment with a dietitian. There are glaring issues with this. Firstly, the DBT group was ran by the most patronising woman I have met in my life; she would show me up for asking questions if I didn't understand something - in one session taking the time to say "and for Lizi's benefit, this means..." every time she explained a new topic. How fucking unprofessional is that? Of course I wouldn't want to keep going back if that's what they're offering me as 'treatment'. I didn't realise public humiliation was part of DBT! Also, what fucking genius thought that putting somebody with crippling social anxiety into group therapy with a bunch of strangers would work out? I don't care how many times you claim it's a Safe bastarding Space, I was treated better by drunken perverts when I was doing bar work.

 Secondly, and this is the kicker, what the fuck is a fucking Dietitian going to do for me*? I refused the appointment because believe it or not I know what sort of things I need to be eating to keep my weight up, I know exactly how many meals, how much, what macro and micronutrients I need to be putting in my face to maintain a healthy body. The issue is that I can't. I just fucking can't. The last time I checked, having a piece of paper that says "I'm a food doctor, I know what you need to be eating" doesn't also come with a bonus Magic fucking Wand that will suddenly make me able to eat without wanting to a) throw it all up again or b) tear off my skin because I feel so fucking afraid and disgusting every time I put food in my mouth. I didn't take that appointment because I know exactly what sort of strain the NHS and Mental Health services are under and there are thousands of other people who need that appointment more desperately than I do. 

*note - no offence to any dietitians out there, and you probably do a lot more than tell people what to eat but that's how your job was explained to me and (as you've probably gathered) I'm a stubborn cunt. Just let me be angry for now - or lend me that Magic Wand.

 So that puts me in an awkward position. Either I go back to the start of the queue, wait however long it takes to be seen for an assessment by the Newcastle team, probably involving going through all the bullshit of talking therapies and CBT again - where I was at five years ago - and hope and pray to whatever deity I don't believe in that I'll be able to get help not only for my Eating Disorder but for other aspects of my mental health. Oh yeah, according to Newcastle I seem to be "doing okay/managing" in other aspects of my mental health so I'm not considered at risk or in need of treatment. They totally ignored my CPN telling them about me being sexually assaulted the other month, and that she also believes that my specific personality disorder is BPD. In the words of my friend Annie (total babe) you wouldn't treat any other illness like this, you wouldn't say to a diabetic "okay so we know you're diabetic, but you haven't slipped into a coma recently so we should just wait and see how it goes!". And Eating Disorders aren't just Mental Health conditions, they affect your physical health too. Gateshead services made sure that I had regular physical health checks, everything from my weight, blood pressure, blood tests, ECGs (heart monitory things), how my ED has affected my asthma. I'm not a doctor and I don't have X-ray vision so I can't see the physical harm I'm doing to myself without their help; and as the saying goes it's "out of sight, out of mind" for me. If I'm not monitored then I can easily go straight back to indulging the voices in my head and continue losing weight without knowing what harm I'm doing. 

 That brings me to option number two. As above, I can continue losing weight in a bid to pull myself out of this miserable 10 year slog in an attempt to actually get treatment - or die trying. I'm far from the only person living with an ED who will have considered this as a viable option, in fact I know I'm not - you can read the reality of this trend for yourself. I say trend, it's more of our last resort in some ways.

 I fucking love the NHS. I wouldn't be alive without the bloody thing, for more reasons than I can list without making this longer than it already is. But it makes me sick to my stomach knowing that we have a government that has made so many funding cuts, putting so many lives at risk, that we now have a system only able to treat ailments when they become life-threatening. Treating the symptoms rather than the cause. 

Current Self:
Slightly sunburned, back from holiday,
trying to hold myself together.

 I'm feeling a lot of different things right now and hopeful isn't one of them. Current ED treatment plans seem more like they're treating the symptoms rather than the cause. It vaguely reminds me of the Cat and Mouse system used when the Suffragettes were imprisoned: let them starve, recuperate at home, then haul them back inside once they start being a problem again and force-feed them as the eventual solution; kicking them out again and starting the cycle over again. Without front line services in place, free at the point of use from the NHS, then how can we expect people to recover as well as they can from disordered eating? We can't, plain and simple. So in the spirit of 2018, if we really want to mark the centenary of the Women's Suffrage Movement, then we need to stop using the same methods to treat people living with and suffering with Eating Disorders.



To sort this whole shit-storm out in a productive way, I'm going to my GP in the morning, and hoping this is all a ridiculous miscommunication. I won't be wallowing in this and doing nothing about it. Either way I'll be making something of this anger, even if it's just sharing my experience to add to the list of reasons we need to improve the NHS and stop cutting its fucking budget. Seriously, how can you class anything as overspending if it's being put into a service that literally can stop people from dying?

Mental Health Trends and Mindfulness: Just Give Me My Damn Pills

 Current mood: wine, bitter, pissed off. Improving.

 This is going to get a bit heavy and rambly in places, as I'm not in the best one at the minute.

 I've been going through some part of the mental health service or another since I was sixteen. I'm not embarrassed about it and I shouldn't be. The majority has been one-on-one counselling, though I had some brief flirtation with group therapy; that was a fucking barrel of laughs and it's just kept getting funnier. It's been wonderful in the past few years to see more people opening up and finally talking about the matter. Yet I've noticed as more people come forward there has been more and more marketisation of services and self-help. One night, at an extremely low point, I rang the Crisis Team and was asked by the guy on the phone if I had tried a colouring book, or a mindfulness app? Of course! Because when somebody is feeling at absolute rock-bottom all the need is to do some pretty pictures or piss about on their phone. Not to mention that sleep deprivation is a key factor in many people hitting crisis point, and the light from electronic devices being proven to negatively impact those sleepy hormones, so hunching over your smart phone is obviously the best thing to do. Anyway, I'm getting off topic. 

 Mindfulness has been lauded as some sort of mental health buzzword in the past few years and honestly? My mind is totally full. I know when I'm being a dick. I know when I'm being irrational. I know why I want to behave like this, even when I know it's not healthy. There's honestly so much crap in there I've reached the brim, and I know I'm nearing boiling point. Tell me one more time to colour in and I might take that pencil to your eye. The mental health system itself has a history of taking the sticky plaster approach: treating the symptoms rather than the root cause. I firmly believe that if service users had more one-on-one work to establish the cause earlier on rather than throwing them into whatever therapy type is trendy at the time then it'd save a lot of time, money, and suffering all round. 

 Historically, if you go back one hundred years or so then the popular thing to do was stick anybody with a mental illness in an asylum. It required two doctors' signatures for admittance, but eight for a release. Fifty years ago they were handing out lobotomies like they were "i didn't bite the dentist" stickers. Twenty years ago it was all about popping pills and self-help books. Now we're in somewhat of a limbo phase of what could be a brilliant mental health service, or the lunatics taking over the asylum, so to speak.

 I get that arts, crafts, and writing can be helpful for mental health. Fuck sake, I'd be a hypocrite if I didn't! Half of the posts on here are the result of some crazed manic or depressive moment. I've been through CBT, DBT, talking therapy, psychiatric evaluation, waitings lists, medication, medication changes, medication withdrawal. And what has been most consistent through all of that is my medication. Other than the brief month I had my meds changed and I believed I was the She-Kraken from the depths of Hell. That was... Not fun. For anybody. At all. Anyway. I had my last psychiatric evaluation over a year ago now and, while I have a Community Psychiatric Nurse (CPN) to work with and she's absolutely wonderful, I have yet to have an updated diagnosis from that evaluation. And the funny part? My original referral was for eating disorder treatment. Have I had any targeted help for that? Have I fuck! 

 But after countless rounds of CBT and Talking Therapy I was finally referred for DBT with my CPN (I'm busting out all the acronyms here!) I've had a look through what DBT is and to be honest? I get it. I get what Dialectical Behavioural Therapy is, I get what it's used for, and I get how it can be helpful. However I also believe that the whole premise of how it's presented is utter bollocks. In my last appointment I was asked if I'd been remembering my something-or-others, I'll call it my 'Here Man!s' for the sake of this post. And I truly couldn't remember what it was! Because it was, like, six simple points that had been over complicated in order to sound scientific and medical. It was something to do with physical health, eating, exercise and other bollocks. But having it called a 'Here Man!' when I'm trying to finish my final year of uni, at a time when what I should be focused on learning Sociology and key feminist theory, finishing my dissertation, I'm stuck in a counselling room trying to remember what 'Here Man!' stands for. And it isn't even that word, it's some other twisted acrostic poem to make the whole practice of therapy sound more scientific and weighted. Almost like those stupid songs or rhymes you learn in maths and science classes to calculate average speed and other bollocks. I can understand to others that it might make the therapy type seem more 'real' and 'provable', but to me it just makes me want to punch whatever bastard came up with them in the face. I get the principles, I get the helpful methodology, but asking me to remember what 'Here Man!' means makes me feel tested. It puts performance pressure on me in a space where I've come for treatment and I can't do it. It's like asking for help and then being reminded that you're under exam conditions and that you're the failure for not remembering it. 

 My CPN said to me this week that I seemed unusually distracted. She's used to me spacing out sometimes but this session was rife with periods of me staring off into space, partially listening and not really taking anything in. And I wholly agree. I felt that I'd failed, not remembering what 'Here Man!' stood for, as it was something I should have been practicing in order to get better. But again, when you're at such a low point that you don't even want to get out of bed or open your eyes, do you really want to waste your time trying to remember what the H, the E, the R, the other E, etc, all stand for? 

 One of the suggestions from this session was that I check out something called the Recover College Collective. It offers BTECs and stuff and helps with mental health apparently, it's like peer-mentoring for crazy people. I had a look at the 'prospectus' with my CPN and, while it sounds interesting, I completely zoned out. Emotional regulation through interpretive dance? Art classes? Writing? This is the shit that turns me off therapy. I'm sick of sticking fancy labels on simple concepts to make them sound more credible. I'm sick of colouring books being the cure-all solution for anxiety. Because when people hit a bad patch, try these things, and they don't work, we feel like failures. We feel like we're failing at getting better. And it's not fun. It's really not fun.

 I'm not writing this as something against these therapy types or anything else, I'm writing it from my experience. Giving something a stupid name and label doesn't make it a cure, and it doesn't make it helpful. It might make it sound more credible to those who try to measure it as a biological experiment, but for me it just means frustration. It means headaches I don't need, reading I don't want to do, and interacting with new people that I don't want to meet. All I want is a therapy type where somebody will tell it how it is, without making it sound either sciency-fancy or arty-farty. Is that too much to ask?


 Note: this isn't me condemning these therapy types, I can't stress that enough. But shoving them down somebody's throat when they're already sick to fucking death of saying 'help, I don't understand' isn't helpful.