Recovery Isn't A Destination:
It's An Ever-Evolving Process
‘I used to weigh just X stone!’ the headlines screeched, next to pictures of sad, emaciated white girls in sagging cotton underwear.
Back when I was in the clutches of bulimia nervosa, which I now believe was a coping strategy for ongoing anxiety, this was pretty much the only barometer I had for what ‘recovery’ was – weekly gossip rags who told stories of mental illness through before-and-after pictures and details of calories consumed and pounds shed. Before the double-edged sword of widespread social media use, this was all the information most people could access.
I’d been to my GP, who swiftly instructed me to stand on the scales, told me I ‘wasn’t underweight’ and sent me on my way, keen to get on to his next allotted six-minute patient slot. I’d rung a charity helpline and happened to be put through to a volunteer who was a dentist and gave me some advice on looking after my teeth after purging which is the only reason I still have any today. But as for the notion of ‘recovery’ – having a ‘normal’, even joyful relationship with food and shedding the sense of being ‘other’ which plagued me constantly – I didn’t even know that was possible.
Twenty years later and, in some ways, the way we understand mental ill health has evolved considerably. Countless awareness campaigns have succeeded in reducing stigma. In others ways, however, it’s exactly the same. My friend and fellow campaigner Hope Virgo is fighting to change the way eating disorders are diagnosed with her campaign ‘Dump the Scales’ because many health professionals are still using weight, rather than emotional distress, to measure severity. Meanwhile, I have set up the Mental Health Media Charter, a simple set of rules for anyone who wants to report on mental illness responsibly and without perpetuating unhelpful stereotypes, because the media still have a tendency to fall back on damaging tropes: the terrorist who it is claimed has undiagnosed and unidentified ‘mental health issues’, the graphic pictures of self-harm and the obsession with documenting a person’s ‘lowest point’ without giving extensive information on how they got better.
If recovery is mentioned at all in most mental health reporting, it’s usually an afterthought – demoted to a brief paragraph or sentence, along with instructions to ring a helpline if we are struggling. Yet the truth is picking up the phone, booking that doctor’s appointment or telling friends and family is just the first step towards what is likely to be a lengthy process.
In that spirit, I’d like to share with you what recovery has looked like, for me, so far:
With hindsight, I can see I have had symptoms of anxiety since I was about ten. However, back in the 90s anxiety was rarely spoken about and, even when I had panic attacks, it was assumed by medical professionals they must be down to asthma or allergies. I struggled through my teens, often wondering why I found some aspects of life so hard. However, anxiety also gave me a compulsive drive. I was a perfectionist and overachiever, which meant good grades and therefore I was never considered in need to special attention.
It was only when I developed an eating disorder that I realised something was wrong. Even then, I didn’t connect this to my mental health. I assumed I was simply vain, or had ‘normal’ body image issues, a notion compounded when I did confide in a few friends and they shrugged off my concerns, telling me ‘all women make themselves sick occasionally.
After that first visit to my GP, which was about three years into my eating disorder, I was too ashamed to seek help again. I interpreted his remark about my weight as meaning I ‘didn’t deserve’ help and was taking away valuable resources from those who did. Around five years later, I could no longer conceal the symptoms of bulimia. My naturally olive skin had turned ghostly pale, my hair was falling out, my face was bloated, I always had a sore throat, runny nose and stomach cramps. I also had more serious symptoms, like frequent heart palpitations and dizzy spells. I was behaving increasingly erratically, drinking too much alcohol to self-medicate and often embarrassing myself in public. It was clear to everyone who knew me I had a problem, although many still struggled to identify it.
In not acknowledging that recovery is an ongoing and ever-evolving journey, we condemn people living with mental illness to believe they will magically and spontaneously 'get better'
I confided in my Step-Dad, who took me to be assessed by NHS mental health services. I was diagnosed with ‘severe bulimia nervosa’ and put on a 12-week waiting list for therapy. Not wanting to wait, my parents offered to pay for me to have therapy privately. I opted for NLP (neurolinguistic programming). Even though it is not a method recommended by the NHS, NLP
appealed to me because of its emphasis on changing behaviour and because my therapist said he didn’t need to know anything about my medical or psychological history, which I didn’t yet feel ready to discuss.
NLP was not entirely unhelpful, however I will say it gave me a ‘placebo recovery’. Many of the people who work in NLP are a bit evangelical and claim to have skills beyond their actual qualifications. My therapist had told me I could expect to be ‘cured’ after just three sessions and, because I believed him, for a while I was. However, it wasn’t long before I was back to bingeing and purging. I realised that whilst NLP had put a temporary stop to the behaviours associated with my eating disorder, the feelings and thoughts had never gone away.
In not acknowledging that recovery is an ongoing and ever-evolving journey, which often involves relapses, we condemn people living with mental illness to believe they will magically and spontaneously ‘get better’ and that if they have a bad day, or revert to harmful coping strategies they are ‘back to square one’. Whereas, as I say in my book A Beginner’s Guide to Being Mental: An A-Z, recovery is actually much more like knitting: Sometimes you drop a stitch, but that doesn’t mean you haven’t already knit the row.
Next, I tried CBT. This was much more effective in tackling my behaviours long term. I learned about trigger foods, which I cut out of my diet temporarily, as well as ‘mindful eating’ which helped me to control the urge to binge. Over the course of about a year, the bulimic behaviour ceased organically and sustainably.
However, I still felt ‘not quite right’. Around this time, I visited a private clinic for a work project and the therapist talked to me about ‘primaries’. She explained that mental illnesses often borrow symptoms from one another and that the trick was often identifying the ‘primary’ condition. For example, do you drink to self-medicate because you are experiencing depression, or do you have addiction issues with alcohol, which is a depressant, causing low mood? This got me thinking about why my eating disorder had started in the first place.
I realised that I’d channelled all my anxiety into hating and punishing my body and that it was this anxiety which was my ‘primary’. I went to my GP again and was again put on a waiting list. This time it was post-introduction of austerity measures, I wasn’t told how long I’d have to wait and six months later I still hadn’t received an appointment.
Meanwhile, I had found myself in a hugely toxic dynamic at work. I was waking up in the morning and having a panic attack before I’d even got out of bed. I’d also started self-harming. I went to my doctor again, received a diagnosis of Panic Disorder and a prescription for Citalopram.
Antidepressants take a while to get into your system, as we all know. When Citalopram initially made me feel worse, my GP kept telling me to ‘stick with it’. A month went by, then three, then six and my mental health was in steady decline. After spending an evening in the bath dreaming up ways to kill myself, I went back to my doctor and asked to try a different medication.
This time was much more successful. For my first three months on Sertraline I was essentially like a giant baby – I had constant diarrhoea and had to take several naps every day. But I could feel the edge being taken off my anxiety and the panic attacks lessened. I found the courage to do something about my work situation and my therapy appointment finally came through. I was entitled to six sessions of CBT – the standard for NHS mental health services.
Again, the CBT helped with behavioural elements of anxiety – like dealing with crowds. Yet, I felt it was important to start digging into some of the root causes which had led my here. My past, by this point, felt like a bag of poison I was carrying around with me, which needed to be lanced and drained. I booked myself in for private counselling sessions. At £75 weekly for a whole year, they weren’t cheap and I appreciate I was lucky to be able to afford it, but I also knew people who spent that much on getting their hair and nails done, or on gym memberships to ‘make themselves feel better’ and I didn’t see how this was any different.
Each building block in recovery teaches you a little more about your own mind, how to exist in the world, what works and what doesn't
Lifestyle adjustments also helped me to feel stronger. I started exercising. Not, as I had previously, to change how my body looked, but because I found it ‘tuned me in’ to my body and gave me an endorphin buzz afterwards. I conquered a perfectionist habit and started running regularly, despite being neither fast nor particularly impressive with my distances. I realised that didn’t matter, it was about what running did for my mind. I also got a cat (China Girl), finding the routine which began to emerge around feeding and caring for her, as well as the general calmness I felt when I was with her, helped me to manage my anxiety.
I noticed small things, like eating breakfast, could impact my mood for the entire day. I kept a log of what habits served my wellbeing and, over time, found ways to incorporate them without beating myself up if I missed a few days.
My weight fluctuated wildly for the first few years after I stopped bingeing and purging and I learned that I had to make peace with that: diets are a slippery slope, gateways to eating disordered thinking and habits. Instead, I focussed on nourishing myself and enjoying what I ate. Eventually, I settled at a size that felt right for me.
My recovery has had to shapeshift to reflect my changing circumstances and environment. When COVID and lockdown happened, I had to re-evaluate my routine and work out how I was going to manage, for example. You’ll also find that what once worked no longer does, or that you don’t need to rely so heavily on a particular coping mechanism.
Each building block in recovery teaches you a little more about your own mind, how to exist in the world, what works and what doesn’t. It teaches you to check in with yourself regularly, to be attuned to your shifts in mood and behaviour and to act early. Whilst this might sound like a lot of work, it’s a really valuable skill to master and after a while it becomes almost unconscious.
This might explain why people going through the process of recovery are, generally, the sanest people I know.