Supporting Anorexia: Control & Intervention

Annie told me to pull this. She said it was hypocrisy. She told me tonight that she doesn't see a future for us. She told me tonight that she has no one.  That she thinks that I expect perfection. She thinks I don't love her anymore, and that she's not sure whether she loves me. Maybe I'm not acting like I do love her. Maybe I'm struggling with this ED more than I know. As I paste this post back into the blog, please remember that it was written over the course of a week. I hope it helps you, the reader, come to terms with just how rough it is supporting someone with an ED. Maybe you should ignore this and take it as a list of things not to do. Knowing what to do, and actually doing it, are sometimes two very different things.

I hope this doesn't come across as vanity publishing. I really do...

(Ian, 12/10/2008, 20:36)

So. Not posted for a while, and to be honest, this is the longest of them all I think.

Things have been pretty rough for me over the last couple of weeks. My boss has generously given me a few days off, which has helped enourmously to catch up on sleep etc, but it hasn't really helped with the "coping" which, at the moment, is getting harder.

It's difficult not having anyone to talk to. What's worse is the fact that Annie can see when things aren't right, and there is no point in lying to her. As soon as I discuss my fears, it seems her fears return even stronger and her renewed conviction that I'm going to leave comes to the fore. Before long, we're fighting, and I'm not even sure anymore why. We do now, seem to have reached an agreement whereby I can talk when I need to with Annie just listening. This is a tenuous agreement though, because when Annie's ED has a strong hold (or the effects of it), it becomes very difficult.

The girls were away last weekend, and with me devoting time purely to Annie, we had a lovely time. No worrying about cooking, no pressures on me from work, and just a nice peaceful time to relax and enjoy each others company. I dragged Annie out on both days, and we enjoyed a short walk down by the river on Sunday, blowing the cobwebs away, and generally just chilling out. The best news of all for me though, was that Annie managed a light lunch and an evening meal on both days, which must have been tough, but as we discussed later, was made easier by the fact that there were no pressures from the kids or any other extrnal sources.

Monday wasn't so good. I went into the office for the first time in a while, and Annie had a bit of a traumatic day to say the least. Having a conversation over the phone is not one of my strong points. Firstly because there is nowhere quiet in my office, and the only quiet places are within earshot of other people. This doesn't help much unfortunately when you're trying to talk to someone about how much pain they are in, and all the other worries. Dividing your time between someone with an ED, and other demands can be very difficult, and at times I am distracted by work "please do this asap" emails.

So when I got home on Monday night, Annie was not well. She was exhausted, and in a good deal of pain. She woke me up in the middle of the night with her somnambulism, and was not happy. This happened a couple of times during the night, and I found myself laying next to her, drifting in and out of sleep, constantly checking the bed next to me to see if she was still there. When I awoke in the morning and commented on what a rough night it had been, Annie had no knowledge of the events.

Now this has happened a couple of times before, and the arguments we've had while she's been asleep have hurt me, and left me feeling hollow the next day. There is no recollection of the argument, and thus there is no closure to the words we exchange. I'm a brooder too which doesn't help, and as we are all wont to do, I dwell on the negative words rather too much sometimes. I do treat Annie's ED as a seperate entity, but it is really very difficult at times not to take offense at the person who is using words borne of "the voice". I wish I didn't dwell on these things so much.

Talking to Annie about my feelings is a mixed blessing. As I sat at the table one night last week, and poured out random rubbish from inside my head, I couldn't help notcing the sadness in her eyes as she sat there, thinking. I didn't probe further, because, for a change, I needed to get things out. I'd been to see a counsellor earlier in the day - provided by my employer. I was later told that this counselling is often of a "quick fix" type. It was clear that this was the case, as there was little empathy from the lady who seemed to want to just get to the bottom of things. Indeed, after I had recounted the tales that you have read as part of this blog, we both just sat there in silence. Me, waiting for her to say something helpful, constructive or insightful, and her, just mulling things over quietly to finally reply with "hmm... that sounds like it must be quite difficult.". I'm not sure I'll go again. I stated from the outset what I wanted to achieve, which is a mechanism for coping with the effects of supporting someone with an ED. There was recognition that this was even possible from her point of view, and no feedback from my one hour monologue.

I do think that it takes a "skill" for wont of a better word to look after someone who has an ED (or any other type of disorder). Jumping in blind definately doesn't work. You need infinite patience, and the ability to listen and empathise. After my counselling session, I came away thinking that I had better skills at this than the person I'd just been talking to. And even I know that I need help honing these skills.

I've been thinking a good deal about intervention and control recently. How do I intervene without taking control from Annie? Can I do this? Is it possible, or is it not my job, and should intervention be best left to those with the skills?

Control is something that is difficult to understand, as it is based on the perception of the "controller" and the "controlee". As a very simple example, #1 was getting the pep talk last night about "going out". We said that if she went out, we would want to know where she was going, how she was getting there, how she was getting back, and what time she was going and coming back. These things are asked purely to make sure she is safe. Is she going to be walking alone in the dark? Is she going to be with friends? What time do we need to start to worry if we haven't heard from her? However, her perception is entirely different I'm sure. She's a teenager after all. She wants independence. She wants freedom to do as she pleases, and she doesn't want nosey parents sticking their oars into her business. Does she see it as control? Probably. Our words that say we only want her to be safe, could be construed as excuses for the real reason (in her eyes): They're watching me! This is a simple example of control, and how it can be perceived differently. it is control, because, as parents, we state that if those conditions are not met, she's not going out. Is it reasonable? I'm sure parents of teenage girls would say yes, but what about a teenage lad?

Looking at an ED is far more complex. It is borne of a feeling of a lack of control, so intervention is even more difficult, as almost anything that can be perceived by the sufferer as "control" will be. When I speak, I have to be careful that words expressing care and concern are not taken as words of control.

So I did some reading on Intervention, and discovered that, like all concepts, it's a bit more complicated than you might think, so before I start, I think I need to define what I mean by intervention.

For the purposes of this blog, I define intervention as "doing something that would interfere with the natural order of things". From turning off a tap to prevent it overflowing, to taking an axe to a set of scales. Some of the people who have read this blog have intervened by posting comments. Some have chosen not to, by just reading, then moving on to something else. Maybe they come back, maybe they don't, but they choose not to intervene for whatever reason.

And these reasons for intervention are complex. Often, intervention takes place without thinking about it. The tap gets turned off, because that stops the sink flooding, and expensive repair bills. Very straightforward. But perhaps the sink was being filled by someone else for a purpose unbeknownst to the tap-turner-offer (I really must get used to typing in some form of "person"... I don't want to use "you" because that implies I am telling you something. I hate using "one" because it's clumsy. Suggestions, as always, appreciated). That intervention then becomes less useful, because the sink still has to be filled. Am I rambling uselessly here?

OK. Get to the point Ian. Support is a form of intervention. Without support, Annie's Rexia would follow a course of action. Maybe she would get help on her own, maybe she wouldn't. Taking this a step back even further, I am actually intervening simply by being part of Annie's life. I knew that I would be doing that when I contacted her almost a year ago now. Love was the motivating force then, and it remains my guiding light of hope now.

I watch Annie and her ED, and it makes me scared. I don't want her to die. It's that simple. I want her to be happy, healthy, and making me chuckle with Hex My Ex. It is a natural urge (I think) to want to change things when you see them going wrong. Especially if you have made the same mistakes, and can offer advice and help to prevent the same mistakes being made. How many books and DVD's are there out there telling you how to do pretty much anything from lose 200lbs in 5 seconds, to building your own house.

Dragging this back to the point though, when I see Annie suffering, I want to make things better. As someone that has never suffered an ED, my mistake was to assume that simple intervention would save the day. Eating Disorder. Answer:Just eat. Fall flat at the first hurdle, do not pass go, do not collect £200.

And therein lies the problem with any intervention. If you don't know what it is your trying to help with, how can you possibly know how to help? On the face of it, eating disorders are a relatively common psychological illness. Yet there is no straightforward "cure", despite many many experts' efforts. How then, can you, as a supporter of someone with an ED, help?

Well, you can and you can't. Is that clear? Nope? Good. Now you're beginning to understand the complexities here. Understanding the issues behind Annie's ED is the key for me. I really need to be able to put myself into Annie's shoes, and that may sound easy, but an ED is a devious bastard, and all too often I am lured into thinking everything is OK, only to find out later that it's very much not. Complacency is probably my greatest enemy.

Take this blog as an example. Writing these events down has no doubt taken its toll on Annie. As I read each post, I go to see her and ask if she's OK. Mostly, we chat about what she's written, I put my arms around her, and we hold each other. Not much that has been written here is old news to me. I've heard all these stories several times, which invariably lessens the impact. The problem is that Annie is living with these things inside her head, every single day. To write them down like this is so tough for her, yet I forget sometimes how tough that can be. I need to be there to support her, and I think I am most of the time, but sometimes (when I'm at work for example, and in the middle of something) I fall down. Indeed, it was my idea that she blog this. I see myself as responsible for any ill effects of this, even though it is Annie's choice to post. Was this intervention good? Time will tell I guess, but the magic 8 ball currently says "possibly" (although it also said "yes" in response to "greqgfda gfda d dfsa?". I hope I found a good balance between intervention and control here. I planted an idea, and Annie (for the most part) has carried it through.

Getting help from Sue though had to be her choice. Again, I suggested it, but I couldn't arrange the appointment. When Annie finally did it, I cried with relief. I think Annie was a little surprised at my reaction, but these tenative first few steps are so important because they are actually steps in the right direction.

So today, I read a site that Annie has pointed out to me: Anorexia Carers. It is a great site for quick, easy to read information on how to help someone suffering with Anorexia. I will be adding it to our list of recommended links. One of the more interesting analogies on the site talks about the "gremlin" that is an ED. The sufferer is regarded as normal, but with this gremlin on their shoulder. What I partcularly liked about this description is that each step on the road to recovery is like a slap in the face to this gremlin, whose sole objective is to get rid of you (the support) so that it can work on the sufferer un-interrupted. Let me tell you, I relish every slap and kick I give (or help Annie to give) to this horrible little thing. I just wish I could steel myself against the pain it so often causes me, so I could better support Annie.

Part #15

Hypoglycaemia.

It's a term normally associated with diabetes. But it does happen to those who don't eat. The human body needs carbohydrates in order to survive - feed the brain; feed the muscles. I know this. I did an A' level in Human Biol.

My mother is insulin-dependent diabetic. She was diagnosed when I was around 11 or 12. She was vicious when 'hypo'. The first time we witnessed it, the household awoke to her screaming in agony due to the cramps. I thought she had gone mad; my father didn't know what to do; and the only person she called for, repeatedly, was my brother. She was bundled off into an ambulance and 'stabilised' at the hospital. We became inured to it in some ways. We could tell when she wasn't looking after herself - she'd go and treat herself to some delicacy from the bakery, cheat her insulin and then fall flat after these 'fast carbs' had been eaten away by the extra insulin with which she had injected herself. She always used to tell me she would rather I succumbed to cancer than to diabetes.

I recall one night, waking up at around 3am and seeing the kitchen light on from my bedroom window. I went downstairs and saw her making a hot drink. Into it, she was ladling margarine. I didn't stop her - I was only about 13 then and just thought this was some weird way of bringing her out of her hypo, but when she took a mouthful and gagged, I realised she had got mixed up.

She never wanted anyone but my brother when she was very low. She would literally howl for him. I would run to her to hug her and she would push me away abruptly, begging for Paul. I know she wasn't in a compos mentis state of mind, so I definitely do not bear her any ill will for this.

When I returned from Oman in 2003, I used to suffer hypos a lot. And I have suffered 'the real' ones, too, from having injected myself with my mother's insulin as a teenager in order to do away with myself. So I know what they are like. The less you eat and the more you work, the less you can function.

The ex had advised me, by phone from Oman, that I could have monies to pay the mortgage and utilities and that was it. The rest of the monies I had to find myself. So he was living in a rent-free villa, with all expenses paid apart from his clothes and food, on a tax-free salary of around £45,000 (US$90,000) and I had to get a job to feed and clothe me and the girls. As the girls were so young (8 and 6), and I was guilt-tripped by Mother into NOT getting an office job, I went out to clean other people's houses, iron their clothes and work as a dinner lady at the local High School. I have to confess my snobbery here and admit that it felt very ignominious at times. I had been a successful journalist and editor, and now I was scrubbing other people's toilets. But, sod it, I am not that proud when the chips are down.

I was probably cleaning for six hours each day as well as doing two hours at the school. The ironing was delivered to my door every other night and I would get up at 5am to do it. Now, I am not wallowing in self-pity here. I am simply stating what I was up to. That's all. Some days, I would get so stuck into the cleaning that I felt simply marvellous - seeing a gleaming house is something worth stepping back from and saying, Great! That looks bloody good! (And I got paid for it!)

But because I wasn't eating - and I think this was probably the start of the anorexia proper, moving from the bulimia which had plagued me over the previous years - I did start to feel somewhat washed out at nights and weekends. And one weekend it took its toll and I passed out in our local supermarket, Asda (Walmart). I keeled over, fell to my knees and blacked out.

I remember coming to on a public bench in the shop with staff hovering over me and trying to placate the girls with colouring books, sweets, cakes etc. I was utterly bewildered and disoriented. One lady, Wendy, wanted to take me to the local hospital, but I refused and told her I would be more than fine. So she drove me home in my car - we still chat now whenever I go into the shop and she is always kindness itself.

I told the ex over the phone and he grunted.

He was due to return to the UK on leave within a few days. He took the girls up to see his sister in Yorkshire and I decided not to go - for personal reasons (i.e. his sister was a condescending woman who enjoyed nothing better than to belittle me when wearing her D & G/Armani/Gucci/Versace clothes and skitting me for shopping at Second Hand Shops). The girls told me when they returned that they had felt sickened at their laughter at me passing out at Asda. He had related the incident to his sister, C, and they had fallen about laughing when he stated, She f*cking doesn't eat, what the f*ck does she expect, silly, f*cking b*tch!

And this was the man who had promised me we would make 'it work'.

As I write all of this, it does read back like wallowing in self-pity. But please believe me, I am not. I actually feel quite stalwart! I actually can read it and think: Well, you git! You purported to love me and did this?! I am well rid of you, matey!

That's truly what I am feeling - I don't want any sympathy. These are just facts - not 'please-like-me-and-feel-sorry-for-me statements'.

But in a roundabout way, what I am trying to say is that my behaviour, without carbs, is erratic. I forget so much, short-term memory-wise. I stagger and slur at times because I am not up to speed. I wake up in a 'swamp' of perspiration from the night sweats, and the cramps are very painful at times, let alone the lack of circulation wherein I have to plunge my hands into the sink full of hot water.

But honestly, I can, actually, see a light at the end of the tunnel. I think this is actually the first 'Memory' post wherein I don't feel sad - I feel quite detached. I am just getting it down. If it offends anyone, I apologise. But what is a blog, if not a journal of thoughts and memories? It can be used for vanity, catharsis, antagonism...many things. Mine is used for catharsis. And that's it.

And that's all for today!

Part #14

So. First therapy session has now been and gone - this morning at 11am.

The dread I was feeling prior to this morning dissipated during the night and I woke up feeling numb, unwell and hollow. There had been a few 'Will she? Won't she?' moments, I must admit. I think, upon waking today, I had just resigned myself to the inevitable, but not in a defeatist way.

I really have felt unwell today. I cannot begin to express the pain which is searing through my legs and hips. Every step I take is like having a red hot poker going up through my pelvis. Sitting, standing, lying down, walking. I don't get any respite, no matter what position I attempt. It was a bit difficult for me to get comfortable at the therapist's. Although she had a huge sofa chair and also offered me a cushion, it just wasn't happening. Added to this, my bowels were on fire from the laxatives I had held off from taking until the very last thing, last night.

I allowed myself some pride in my efforts yesterday. I didn't go near the scales and had it in my head NOT to take any Dulcolax. I nibbled on 'safe' foodstuffs through the day and drank quite a lot of milk. So, I retired feeling pretty pleased with myself. But the slightest thing can make me feel inadequate and an ill-perceived slight led me to the Dulcolax and the fridge...then the toilet...And it was all my fault, and I know that to be true.

The therapist was everything I hoped she would be. Her name is Susan. Her room was like a sparsely-furnished living room, but not so austere as to make you feel cold and uncomfortable. And she was approachable, warm, understanding, pertinent and competent. She didn't make me feel a time-waster like some therapists have. And nor did I think she would feel I was fabricating things - indeed, I asked her that after she remarked that I had been surrounded, for many years, by people who had criticised me and dragged me down.

It's a strange thing when someone acknowledges this. Although I want someone to understand, the minute they do, I feel inordinate guilt - as though I have been 'naughty' and ratted on someone. She remarked on this, too. It's normal to respect your parents, and therefore, when you have no respect for them, it goes against the norm...if you know what I mean? 

We talked a lot about Anal, actually. Probably more about him than my family. We also talked about my relationship with Ian and the girls - I think these mentions were the only ones at which I smiled. I also confessed the one thing I have 'achieved' at which I do, secretly and quietly (but not any more, I guess!) give myself a pat on the back for - and that's the integrity I have instilled into Beth. Beth has more moral fibre than any person, adult or child, I have ever known. She looks out for the underdog, is fierce about right and wrong, and is not frightened to stand up for the 'right' side, either. She's as vocal and adamant as I wish I could be. We've talked morals together for hours on end. I've tried to teach her right and wrong; about love, care and consideration - about unconditional love. She's soaked it up like a sponge. Rosemary also has these morals - I am sure of that as I witness the way she defends her friends when they are in trouble...but she, at the moment, is absorbing boys, make-up and education more than 'fighting the good fight'. And that is how it should be for her, too, at this time of her life.

I must confess that this first session was quite draining for me. I had to use the bathroom part-way through and suddenly found myself wanting to 'grey out'. Some deep breathing cleared my head and didn't make me lose my sight. It left me feeling very nauseated, though, and I admitted to Sue that I felt somewhat unwell. She offered to end the session, but we ploughed on.

These spider webs of memories can be painful. Ian and I went to the pub afterwards for a chat. And I tried to relate to him as much as my tangled head could recall. So much junk in there which needs taking to the bin and destroying, once and for all - no recycling here, thanks!

When I was little - I can't think that I was much more than 7 or 8, I ended up in hospital. I had made myself ill with my own thoughts, I guess. My mother was constantly threatening to desert me; impressing upon me that her own unhappiness and malcontent with my father was due to my existence - "I'd have left if it hadn't have been for you being born" - and I started to fear that every time I left the house, I'd return to find her gone. I stopped coping with food due to the nausea. I found eating very, very difficult. And I also started pleading sickness in order to stay at home and keep an eye on her. Ensure that she didn't leave without me. I lost a lot of school that year. My mother took me into her bed with her at night because I was sick so much. I liked that even more - I had her under my beady eye 24/7 in effect.

When I started vomiting blood regularly, I was taken into hospital. The medics suspected kidney or liver damage but tests revealed nothing of the sort. I had hospital schooling for a while and pleaded to go home on what seemed like an hourly basis. My mother had been told she could stay with me in her own room if she wanted, but she decided that she didn't. So, I didn't have her anyway.

Upon my discharge, tensions were very high at home. My father was sick of me; my mother was, too, and I was just so bloody terrified of my own shadow that the nausea was there on a permanent basis. I started vomiting, involuntarily, at school, too. I'd only have to have a drink and it'd come straight up. And I could never get to the toilet on time. The amount of times my teacher berated me are numerous.

My mother has mentioned this time to me only once and described it as when I was 'a total pain in the arse and going round the bend...' Then again, she has often described me as a 'useless bastard'...

I did get over it. My father threatened me with all sorts of punishments if I didn't 'straighten [myself] up'. So I had to as he terrified me. One particular night, when he had really had enough of me whimpering for my mother's return, he smacked my backside so hard, it was raw, and then threw me into a scalding hot bath from which I was not allowed to move. The heat was so high it was like ice, almost. I cried quietly, not daring to move as this would mean the heat circulated even more. He roared at me to stop crying, but the pain was intense and I didn't know what the hell to do. I will never forget that night as long as I live. I remember staring at my face in the bath overflow, all distorted and strange-looking, sitting on my hands, attempting to protect my buttocks. 

My mother has denied this event ever happened. That my father would never do any such thing. But how would she know? She was out dancing with her fancy-man.

Ian has referred to this, and other things, as 'abuse'. It doesn't sit easy with me. I often remark, At least I wasn't abused as a child. He refutes this. It's hearkening back to my statement above. One doesn't want to think ill of one's parents, and to do so goes against the norm.

I told Sue today that I really miss 'A Mum'. Not her - A Mum. She discussed this with me very empathetically and perceptively. I got a lot out of her empathy there as I have often felt a bit of a wuss admitting it. Many people are unlucky enough to lose their parents and some struggle to get over it. A close friend of mine is still heartbroken at the loss of her lovely Mother and I have wrestled with my guilt at divulging my own feelings towards my mother to her. Thankfully, she is an objective woman and can see big differences in my upbringing to hers. (And thanks for that, Melon.)

So, the start of new and hopefully good things to come. I explained to Sue that I want to get rid of this rubbish once and for all. She has told me, honestly, it's going to be a long journey. I know that - I'm not daft! 38 years of incessant degredation and criticism don't disappear in six weeks, do they?

Ian told me today that he was proud of me for taking this step. He told me he wondered if I would go through with it as twice I had threatened to cancel. I have asked him to turn Captain Caveman on me if I wobble, sling me over his shoulder and club me. But get me there. We got into a bit of a debate as to 'who should be thanked/praised the most'. I have agreed to disagree on this one and asked him to tell me he is still proud in about four weeks - perhaps I will then have the grace to accept it?