Saturday, October 7, 2017

Hunger Hurts, but Starving Works: Part Four  

This is part four in my series on the neurobiology of restrictive anorexia nervosa. As a reminder, the following information may be triggering or difficult for some readers. Please keep yourselves safe.

If you need to catch up, you can find parts one, two, and three here.


I apologise for the MASSIVE delay in getting this next instalment out to you all. As I explained in this post, I’ve been having a rough time and a lot of things were put on hold. This blog and this series was one of those things. However, I always intended to finish it because I know it can be so helpful to understand the science of these things, so by golly, finish it I shall.

We last left off [In July, Y I K E S] talking about dopamine. You can have a refresher of that post here.
As with the previous posts, the black is verbatim from my original paper, and the purple is my added blogger-friendly breakdowns. Some parts of my original paper have been omitted because they don’t add anything in the context of this blog post. Friendly reminder that this is all secondary research and there if a full reference list behind the spoiler if you want to read up on anything I’ve discussed. I am a student, not a psychologist, and I can only assume my information is correctly interpreted due to the grade I received for this paper. I am no expert so if you see an error, please do let me know.

Alright. Brace for impact.


Hunger Hurts But Starving Works: The Role of Serotonin and Dopamine Anorexia Nervosa [Part Four: Dopamine, Rats, Binge Eating, and Food Hoarding]

Food intake is dictated by a complex interaction between the brain and body (Lak, Stauffer, & Schultz, 2014). The overarching neurobiology is the brain reward system, which integrates hunger signals with cognitive and emotional factors to regulate eating behaviour (Berridge, 2009). In the context of AN-R, research suggests that extreme eating and exercise behaviours can modulate the brain regions involved in reward processing, thus mediating the dopamine system (Frank, 2014). Extreme terms of either restricting relative to energy requirements or overeating. This process has consistently been modelled by animal studies, and perhaps the most well-known of these is activity-based anorexia in rats. In this model, first demonstrated by Routtenberg and Kuzzesof in 1967, rats on a severely restricted diet are given free access to a running wheel. Within a few days, the rats exhibit excessive exercise and a decline in body weight so severe that without experimenter intervention, it leads to death (cited in Avena & Bocarsly, 2012). Who knew that you could create anorexic rats, right? It raises some extremely interesting questions, which were unfortunately beyond the scope of this paper. There are a number of possible explanations for the over-exercise exhibited by the rats in this model, and by extension, individuals with AN-R. Two such explanations are that this behaviour is due to stress, or that it is a form of foraging or food-seeking behaviour (Adan, 2011; Gutierrez, 2013, cited in Chowdhury, Chen, & Aoki, 2015). Meaning we are hungry, so we are subconsciously exercising [eg running or walking] in an effort to seek out food. This implicates the mesolimbic dopamine neurons, as food restriction and excessive exercise can lead to a stress response mediated by these neurons (Trainor, 2011). This stress response increases cortisol and corticotrophin releasing factor, which results in a surge of dopamine that consequently rewards food restriction and exercise behaviour (Sodersten et al., 2016). Basically this means, it messes with the wiring in your brain so that restricting and over exercising are rewarding by a reduction in dysphoria or other unpleasant feelings. It numbs you out, reduces your stress, and helps you cope. This creates a feedback loop not unlike those seen in drug dependent individuals, whereby engaging in the behaviour results in a surge of dopamine, which in turn creates a habit or compulsion and increases the likelihood of engaging in that behaviour again, which causes a surge in dopamine and so on (O'Hara et al., 2016). This is exactly what happens to those addicted to substances. Interestingly, it occurs also in those addicted to sugar, such as chronic over eaters, binge eaters, or those with AN-BP or bulimia. I want to do a shorter post on this in future as there are some fascinating studies out there. One such study indicates that sugar targets the same brain areas as cocaine. Biopsych [the unit I wrote this paper for] was SUCH a fascinating subject, honestly. As a sidenote, my original paper idea was going to be based on the notion that eating disorders are an addiction, but the word limit meant I wouldn’t have been able to discuss it in the level of detail that I wanted. Each eating disorder has a different pattern of brain chemistry changes, and so I had to focus on only one ED. I chose AN-R because although I deeply contest it, it is in my diagnosis list and therefore is of personal interest to me. But I digress



Furthermore, high corticotrophin releasing factor appears to increase dopamine responses that supress food intake while simultaneously stimulating food seeking behaviour (Stengel & Taché, 2014). This provides one possible explanation for the high levels of food preoccupation seen in AN-R; rather than eating, suffers become obsessed with food, perhaps preparing elaborate meals for others, collecting cookbooks, or even hoarding food without eating it (Thurston, 1999, cited in Sodersten et al., 2016). I myself am a MASSIVE food hoarder. I know many of you reading this are too. You’re not alone and you don’t lack self-control. Part of the reason we hoard food is that our bodies and brains want it and so we feel compelled to have it around. That doesn’t make you a bad person. It’s biologically driven. Animals do it too, as do individuals who have their food restricted outside their control [eg, neglected children]. It’s almost to be expected when your intake is inadequate for your energy requirements. This may also explain the difficulties in the modulation of food intake experienced by both individuals recovering from AN-R and non-eating disordered individuals following a period of food restriction (Kalm & Semba, 2005). It is common for individuals with AN-R to experience binge-eating during weight restoration, as such dysregulated eating behaviour is related to altered dopamine receptors and reward sensitivity (Avena, Rada, & Hoebel, 2008). This means that again, the change in your food consumption changes your brain chemistry and your brain goes into survival mode, pushing you to eat as much as you can for fear that you may start starving again. Many people describe it as being physically full yet mentally hungry, and it is an absolutely accurate description. So next time someone tells you that extreme hunger or binge eating following a restrictive eating disorder is just a matter of self-control, or that you’re “pigging out on McDonalds” or that you’re acting like you're “on holiday from your ED” [both examples of things this borderline braindead MORON said to a friend of mine], I want you to pick up your laptop and slap them in the face with this paragraph. Extreme hunger is real. Extreme MENTAL hunger is real. Have you ever heard of the Minnesota Starvation Experiment? If not, you can read about it here. I would love to talk more about it, but this blog post is already so long, eeep. I don’t want to ramble too much. But do read up on it, if this is of interest to you. And remember, if you find yourself bingeing after a period of restriction, it doesn’t make you weak, greedy, pathetic, fake, or any of the nasty things your head says about you. It makes you human. Even if you’re weight restored. Even if you’ve overshot your ‘target’ weight. Your brain doesn’t know that you’d like to be XXkgs. All it knows is you’ve been starving it or restricting it and so now it wants food and it wants food NOW. That’s not your fault. And it doesn’t make you weak. Each of these explanations implicates the dopaminergic pathways and provides compelling evidence that dopamine plays a key role in the neurocircuit function of AN-R.

I wanted to combine all the remaining information into this post, but that took it to over 3000 words with my commentary. And so, although I am loathed to do it, I am going to stop here on this post. There’s one more post to go that looks at how the 5-HT and dopamine systems interact to create and regulate the symptoms of AN-R, treatment options, the limitations of the research presented, and where do we go from here*

Take care and please speak to your GP, therapist, dietician, or other healthcare professional if you are struggling with food or eating or exercise. Here are some resources that may be of use to you if you are struggling.

Be safe.
Xx

*This is largely influenced by the fact that my illness has me sitting on my butt all day watching Buffy, but all I can hear is,
Where do we go
From here?
Where do we go
From here?
The battle's done
and we kind of won
So we sound our victory cheer
TELL ME
Where do we go from hereeeeeeeeeee?





Screenshot from the Netflix film 'To The Bone'


<Can't get the spoiler to work and will come back to edit it later, but for now, here's the unspoilered reference list>

References

Avena, N. M.,& Bocarsly, M. E. (2012). Dysregulation of brain reward systems in eating disorders: Neurochemical information from animal models of binge eating, bulimia nervosa, and anorexia nervosa. Neuropharmacology, 63(1), 87-96. doi:10.1016/jneuropharm.2011.11.010




Avena, N. M., Rada, P., & Hoebel, B.G. (2008). Underweight rats have enhanced dopamine release and blunted acetylcholine response in the nucleus accumbens while bingeing on sucrose. Neuroscience, 156(4), 865-871. doi:10.1016/j.neuroscience.2008.08.017

Bailer, U. F. (2007). Exaggerated 5-HT1A but normal 5-HT2A receptor activity in individuals ill with anorexia nervosa. Biological Psychiatry, 61(9), 1090-1099. doi:10.1016/j.biopsych.2006.07.018

Bailer U. F., Frank, G. K., Price, J. C., Meltzer, C. C., Becker, C., Mathis, C. A., … Kaye, W. H. (2013).  Interaction between serotonin transporter and dopamine D2/D3 receptor radioligand measures is associated with harm avoidant symptoms in anorexia and bulimia nervosa. Psychiatry Research: Neuroimaging, 211(2), 160-168. doi:10.1016/j.pscychresns.2012.06.010

Berridge, K. C. (2009). 'Liking' and 'wanting' food rewards: Brain substrates and roles in eating disorders. Physiology & Behavior, 97(5), 537-550. doi:10.1016/j.physbeh.2009.02.044

Broft, A., Slifstein, M., Shingleton, R., Kenney, L., Attia, E., Martinez, D., . . . Osborne, R.. (2015). Striatal dopamine type 2 receptor availability in anorexia nervosa. Psychiatry Research: Neuroimaging (233)3, 380-387. doi:10.1016/j.pscychresns.2015.06.013

Bosanac, P., Kurlender, S., Stojanovska, L., Hallam, K., Norman, T., McGrath, C., . . . Olver, J. (2007). Neuropsychological study of underweight and “weightrecovered” anorexia nervosa compared with bulimia nervosa and normal controls. International Journal of Eating Disorders, 40(7), 613-621. doi:10.1002/eat.20412

Carter, J., Blackmore, E., Sutandar-Pinnock, K., & Woodside, D. (2004). Relapse in anorexia nervosa: A survival analysis. Psychological Medicine, 34(4), 671-679. doi:10.1017/S0033291703001168

Chowdhury, T. G., Chen, Y.-W., & Aoki, C. (2015). Using the activity-based anorexia rodent model to study the neurobiological basis of anorexia nervosa. Journal of Visualized Experiments: JoVE, (104), 52927. Advance online publication. doi:10.3791/52927

Compan, V. (2013). Under- to over-eating: How do serotonin receptors contribute? Future Neurology, 8(6), 701–714. doi:10.2217/fnl.13.54

Corwin, R. L., Avena, N. M., & Boggiano, M. M. (2011). Feeding and reward: Perspectives from three rat models of binge eating. Physiology & Behavior, 104(1), 87-97. doi:20.2026/j.physbeth.2011.04.041

Darcy, A. M., Doyle, A. C., Lock, J., Peebles, R., Doyle, P., & Le Grange, D. (2012). The eating disorders examination in adolescent males with anorexia nervosa: How does it compare to adolescent females? International Journal of Eating Disorders, 45(1), 110-114. doi:10.1002/eat.20896

Deep, A.L., Nagy, L.M., Weltzin, T.E., Rao, R., & Kaye, W.H. (1995). Premorbid onset of psychopathology in long-term recovered anorexia nervosa. International Journal of Eating Disorders, 17, 291–297. doi:10.1002/1098-108X(199504)17:3<291::AID-EAT2260170310>3.0.CO;2-#

Frank, G. K. W. (2014). Could dopamine agonists aid in drug development for anorexia nervosa? Frontiers in Nutrition, 1(19), 1-9. doi:10.3389/fnut.2014.00019

Frank, G. K., Bailer, U.F., Henry, S. E., Drevets, W., Meltzer, C. C., Price, J. C., …  Kaye, W. H. (2005). Increased dopamine D2/D3 receptor binding after recovery from anorexia nervosa measured by positron emission tomography and [11C] raclopride. Biological Psychiatry, 58. 908–912. doi:10.1016/j.biopsych.2005.05.003

Godier, L. R.& Park, R. J. (2015). Does compulsive behaviour in anorexia nervosa resemble an addiction? A qualitative investigation. Frontiers in Psychology, 6(1608), 1-12. doi:10.3389/fpsyg.2015.01608

Hudson, J.I., Hiripi, E., Pope, H. G. Jr., & Kessler, R.C. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry 61(3), 348–58. doi:10.1016/j.biopsych.2006.03.040

Kalm, L. M.,& Semba, R. D. (2005). They starved so that others be better fed: Remembering Ancel Keys and the Minnesota experiment. The Journal of Nutrition, 135(6), 1347-1352. Retrieved from http://search.proquest.com.ezproxy.une.edu.au/docview/197463003

Kaye, W. H. (2008). Neurobiology of anorexia and bulimia nervosa. Physiology & Behavior, 94(1), 121-135. doi:10.1016/j.physbeh.2007.11.037

Kaye, W. H., Bailer, U. F., Frank, G. K., & Wagner, A. (2006). Persistent alterations of serotonin and dopamine activity after recovery from anorexia and bulimia nervosa. International Congress Series, 1287, 45-48. doi:10.1016/j.ics.2005.12.038

Kaye, W. H., Barbarich, N. C., Putnam, K., Gendall, K. A., Fernstrom, J., Fernstrom, M., . . . Kishore, A. (2003). Anxiolytic effects of acute tryptophan depletion in anorexia nervosa. International Journal of Eating Disorders, 33(3), 257-267. doi:10.1002/eat.10135

Kaye, W. H, Frank, G. K., Bailer, U. F., Henrya, S. E., Meltzera, C. C., Priced, J. C., … Wagner, A. (2005). Serotonin alterations in anorexia and bulimia nervosa: New insights from imaging studies. (2005). Physiology& Behavior, 85(1), 73-81. doi:10.1016/j.physbeh.2005.04.013

Kaye, W. H., Fudge, J. L., & Paulus, M. (2009). New insights into symptoms and neurocircuit function of anorexia nervosa. Nature Reviews. Neuroscience, 10(8), 573-84. doi:10.1038/nrn2682

Kaye, W. H., Wierenga, C. E., Bailer, U. F., Simmons, A. N., & Bischoff-Grethe, A. (2013). Nothing tastes as good as skinny feels: The neurobiology of anorexia nervosa. Trends in Neurosciences, 36(2), 110-120. doi:10.1016/j.tins.2013.01.003

Lak, A., Stauffer, W. R., & Schultz, W. (2014). Dopamine prediction error responses integrate

subjective value from different reward dimensions. Proceedings of the Natural Academy of Sciences of the United States of America, 111(6), 2343–2348. doi:10.1073/pnas.1321596111

O’Hara, C. B., Campbell, I. C., & Schmidt, U. (2015). A reward-centred model of anorexia nervosa: A focussed narrative review of the neurological and psychophysiological literature. Neuroscience and Biobehavioural Reviews, 52, 131-152. doi:10.1016/j.neubiorev.2015.02.012

O'Hara, C.,B., Keyes, A., Renwick, B., Leyton, M., Campbell, I. C., & Schmidt, U. (2016). The effects of acute dopamine precursor depletion on the reinforcing value of exercise in anorexia nervosa. PLoS One, 11(1), 1-16. doi:10.1371/journal.pone.0145894

Schwartz, M.W., Woods, S. C., Porte, D., Seeley, R. J., & Baskin. D. G. (2000). Central nervous system control of food intake. Nature, 404(6778), 661-671. doi:10.1038/35007534

Sodersten, P., Bergh, C., Leon, M., & Zandian, P. (2016). Dopamine and anorexia nervosa. Neuroscience And Biobehavioral Reviews, 60, 26-30. doi:10.1016/j.neubiorev.2015.11.003

Stengel, A.,& Taché, Y. F. (2014). CRF and urocortin peptides as modulators of energy balance and feeding behavior during stress. Frontiers in Neuroscience, 8(52), 1-10. doi:10.3389/fnins.2014.00052

Trainor, B. C. (2011). Stress responses and the mesolimbic dopamine system: social contexts and sex differences. Hormones and Behavior, 60(5), 457–469. doi:10.1016/j.yhbeh.2011.08.013

Treasure, J.,& Campbell, I. (1994). The case for biology in the aetiology of anorexia nervosa. Psychological Medicine, 24(1), 3-8. doi:10.1017/S0033291700026775

Via, E., Soriano-Mas, C., Sanchez, I., Forcano, L., Harrison, B., Davey, C., . . . Cardoner, N. (2015). Abnormal Social Reward Responses in Anorexia Nervosa: An fMRI Study. PLoS ONE, 10(7), 1-20. doi:10.1371/journal.pone.0133539

Volkow, N. D., Fowler, J. S., Wang, G-J., & Swanson, J. M. (2004). Dopamine in drug abuse and addiction: Results from imaging studies and treatment implications. Molecular Psychiatry, 9(6), 557-569. doi:10.1038/sj.mp.4001507

Volkow, N., Wang, G., Maynard, L., Jayne, M., Fowler, J., Zhu, W., . . . Pappas, N. (2003). Brain dopamine is associated with eating behaviors in humans. International Journal of Eating Disorders, 33(2), 136-142. doi:10.1002/eat.10118

Walsh, B. T. (2011). The importance of eating behavior in eating disorders. Physiology & Behavior, 104(4), 525-529. doi:10.1016/j.phybeh.2011.05.007

Zunker, C., Mitchell, J. E. & Wonderlich, S. A. (2011), Exercise interventions for women with anorexia nervosa: A review of the literature. International Journal of Eating Disorders, 44(7), 579–584. doi:10.1002/eat.20862

Wednesday, October 4, 2017

‘Cause people got me, got me questioning, where is the love?


This comes with a trigger warning for depression, mild suicide ideation, and talk of recent traumatic events. Stay safe. If you need help, there are some resources listed here.

I’m not even sure how to begin writing this.

I have written [vented] about it extensively on Twitter and Instagram over the last 24 hours. Some appropriate. Some less so, as I, like all of you, struggle to come to terms with yet another mass shooting in the US last night. 59 killed. More than 500 wounded at last count. Not in a warzone. Not on a battlefield. At a concert. A music festival. A place where you go to have fun. Be with your family. Your friends. Your loved ones. Support the artists you love. Connect with one another over shared interests and passions. A place where we should feel safe. Relaxed. Happy.

A place that has now become the target for mass murder on at least four occasions that I can think of from the top of my head. Maybe more.

I want to get angry, as I was this morning when I went on a tweet storm [I apologise for all the times I dropped the f word, as there were a lot], but I have no anger left, I think. Last night I posted on my mental health Instagram that I was drained, and I am. My batteries have run out. I have no anger left to give. All I have left is sorrow. Hurt. Disgust. Fear. And sadness. So, so much sadness.

But.

That’s not what I want to write about here.

I want to talk about caring for yourselves and your loved ones after a horrific event such as this one. There are already some amazing articles available that provide advice on how to cope if you or a loved one are directly affected, how to keep mentally safe, how to talk to your kids, and how to continue to live your daily life in a world where these acts of terror are becoming more and more common, not to mention natural disasters such as the earthquakes and hurricanes that have been plaguing the world on a near-continuous basis. I’m not sure this post will add anything to the conversation, but I am writing it for me just as much as I am writing it for all of you, because I need to remember how to care for myself too. How to keep going. How to not hate myself even more for struggling with what are really relatively minor first world problems in the grand scheme of things when there is so much horror in the world.


To set the scene, let me explain what happens inside my head. Something horrible happens. Every other day, it seems. My head immediately jumps to, You selfish piece of SHIT. How DARE you struggle over xyz when something SO MUCH MORE HORRIFIC is happening! You’re disgusting! And look, now you’re making it about YOU! You’re HORRIBLE. You deserve PAIN and PUNISHMENT. You deserve to DIE. AND LOOK, YOU’RE MAKING IT ABOUT YOU AGAIN! YOU WEREN’T EVEN THERE! You self-centred pile of trash! I hate you, I hate you, I hate you…And so on, until I’m so far deep into the hole that I’m a mixture of devastated by the event, terrified by the event, heartbroken for those affected by the event, ashamed of myself for being upset or devastated by the event at all when [thankfully] not a single one has immediately affected my family or loved ones, and feeling extrEME guilt for having mental health problems at all when my life doesn’t suck. My life is good, actually. I am loved. I am cared for. I have a wonderful and supportive family. Amazing friends. A Magical Unicorn for a therapist [sidenote – I told him I call him that, lol]. A stable home. The ability to study a second degree to get into the career of my choosing. Enough food [oh the irony]. Clean water. Internet access. Medical and mental health care that is largely subsidised by the government. The best dogs in existence [fight me; it’s true]. Enough money to pay my bills and live and buy way too many books and pepsi max. No one in my immediate life has ever passed away. I have never experienced death firsthand. I have so much more than so many others, and yet here I am, unable to get out of bed some days and have currently been wearing a revolving set of pyjamas and a Cookie Monster onesie for like two solid weeks because I’m both physically and mentally struggling a lot more than usual lately. When something horrific like last night’s attack happens, I feel horrendously guilty for being so selfish and ungrateful, and so that just makes me hate myself even more, which makes me feel even MORE selfish and ungrateful, and so I hate myself even MORE, and so…Well. You get the picture.

However. Here are some gentle reminders. Both for me, and for you, if you need them.

·       Someone else’s suffering does NOT invalidate yours. A broken leg and a broken toe both hurt. You are allowed to feel the pain of your broken toe even if someone else has a broken femur or two broken femurs or two broken femurs and a shattered pelvis. Someone else being worse off doesn’t mean you aren’t allowed to feel however you feel.


·       Having a mental illness does not. Make. You. Selfish. Once more for the people [and my brain] at the back. It is NOT SELFISH TO BE SICK. Just because you can’t necessarily SEE the illness doesn’t mean it’s not there, or that it doesn’t impact your life, or that it isn’t valid. As the [heartbreakingly] late Chester B sings, just because you can't see it doesn't mean it isn't there.


·       A tragedy does not and will not magically ‘cure’ you. It seems absurd to even say that, but I so often catch myself feeling like I SHOULD BE BETTER BECAUSE OTHERS HAVE IT WORSE. No. Stop right there. There is absolutely NO need to feel guilty if [when] you still find yourself struggling with your mental health in the wake of a tragedy. In fact, as I explained above, oftentimes the guilt and shame we feel over having these problems when others are suffering, not to mention the added fear and anxiety, can make our mental health issues even worse. Trying to supress your feelings and likely being unable to is not going to help you or anyone else. You are allowed to feel your feelings. As JD would say, Let me feel my feelings, Turk!


·       Do NOT let anyone dictate your response to these things. I saw a lot of, “You weren’t even there! You don’t even live in this country!” bullshit on Twitter this morning, and it was both heartbreaking and disgusting. You are allowed to be affected by things even if it has nothing to do with your life on a personal level, ESPECIALLY when it is such a mass tragedy like what we saw last night. Grief and trauma has no official agreed upon formal diagnostic criteria because it is very individual and what affects one person may not phase another and vice versa. Once again, listen to JD, and feel your feelings however you want or need to.


·       Talk to someone about how you’re feeling. Friends. Family. Loved ones. Therapists. Counsellors. Pastors. Random internet strangers *waves from my askFM account*. Don’t be afraid to say how you feel. Often, that alone can be helpful.


·       Don’t be afraid to turn off the news, log out of social media, and disconnect. This does NOT make you a selfish person. Sometimes these events get 24/7 coverage and media outlets play looped videos of the same horrifying scenes over and over again, which can be difficult for even the most mentally healthy person in the world to cope with. If watching or reading about these events is harmful to your mental health, switch it off. It is okay to switch off. Say it with me: It is okay to turn it off. It is okay to have enough. It doesn’t mean you don’t care. It doesn’t make you selfish. It just means you are human.


·       Spend some time with loved ones, if you can. I watched a movie with my family last night, for example, and it helped, if only a little.


·       It’s been said a lot, but look for the helpers. They are always there. Yes, there are horrible, evil, terroristic individuals in the world, but I promise you, the good people far outweigh the bad. Look for the helpers and see what humanity is really like. The few monsters in this world have nothing on the billions of kind, loving, and decent humans out there.


·       Spend some time recharging, whatever that looks like for you. Read a book. Take a bath. Drink some tea. Play with a pet. Watch a movie, like, perhaps *coughs loudly* HARRY POTTER. LIKE, HARRY POTTER. DID I MENTION HARRY POTTER? NO? OH. HARRY POTTER. WATCH IT.


·       When you’re having a better day, make a list or box of things that can help when you’re having a tough time. It sounds silly, but having a ready-made list of go-to things to help can make a world of difference. I’d suggest having a list or box of happy handy at all times that you can just dive straight into when you need to. For me, as an example, I cuddle my dogs, talk to my mom, journal, blog, write, draw, paint, go for a walk, spend time with my mom or LittleBig brother, watch something I love like perhaps this little film called HARRY POTTER HARRY POTTER HEY DID I MENTION HARRY POTTER, and I have a number of Spotify playlists on my phone for music that will help in various situations.


·       Remember, whatever you’re feeling in terms of emotion, the human brain can literally only maintain high levels of intense emotion for a maximum of 90 seconds if you allow yourself to feel it. Just 90 seconds. That’s all you have to get through. Ninety seconds. That’s not even a whole song on one of those helpful playlists that you made earlier [hint hint]. That doesn’t mean that emotion won’t return again or that it won’t be that intense again or perhaps even worse, but it will pass. It will always, always pass.


·       Look for ways to help. So often we feel helpless, and that adds to the depression and anxiety and the dark and twisty. If you can’t help the immediate situation for whatever reason, maybe just do something nice for someone you know. Send your friend a surprise card. Call your aunt. Hug your mom. Bake your grandfather a cake. Tidy the kitchen for your family. These small acts of kindness can really help you feel better, which sounds self-serving, I know, but remember, it also helps those on the receiving end.


·       Whatever you do, don’t give up hope. Never ever give up hope because as I keep saying,








Be safe, take care of you, and take care of one another.

Xx

Title lyrics: Where Is The Love by The Black Eyed Peas Ft. The World

Saturday, September 30, 2017

People help the people...and if you're homesick, give me your hand and I'll hold it


I posted this as a kind of disclaimer on my askFM as it was brought to my attention that it could be construed as hypocritical for me to be attempting to give advice on mental heath concerns when I myself am mentally unwell.

***



🍃I am not trained in psychology. I am doing a psych degree and have a degree in a related field, but I am not a therapist or counsellor or professional. I'm just a girl.

🍃I started my blog, instagram, and askfm to try to use my experiences with mental unhealth to provide support, understanding, a place to talk, someone to talk to, and encouragement to those who need it. I am here if you want to talk. I will always listen.

🍃That being said, I am mentally unwell. I tend not to list my diagnoses as I fear it sounds like they are Pokemon [Gotta catch 'em all!] but I am not mentally healthy. I am unsure how you qualify mental health vs unhealth, really, but I'm quite sure I fall on the side of unhealth.

🍃This puts me in the position of being able to provide advice based on my actual experiences. I'm not talking theoretically. I live with these things every day. I can only speak to my experiences, but I try to use them to help others as much as possible.

🍃Given that I am diagnosed with restrictive anorexia, I don't share many details about my intake and I don't give intake, weight loss, or exercise advice. My relationship with food and exercise is unhealthy. I disagree that it's anorexia, but that's neither here nor there. I am happy to discuss eating disorders if you or someone you care for are struggling, but I am uncomfortable talking my specific numbers. Other people's numbers don't bother me. If you want intake advice, I would suggest talking to your GP, therapist, or dietitian

🍃I am in treatment and have been for a REALLY long time. I first sought help at 14. In secret. On my own. I started on meds at 19. I've seen every kind of mental health professional you can name. No one is forcing me to seek help. I want it. I need it. And I'm fighting against myself every day to accept it.

🍃Sometimes my words and actions don't match. I'm an imperfect human. I'm doing the best I can on any given day. This varies. Some days I am all fight. Some days I am all tears. Both are trying.

🍃My problems are complex, as is often the case, so I cannot tackle every element all at once. I assure you my therapist knows what he is doing. We focus on the most pressing issues. You may not see changes, but that doesn't mean they aren't happening.

🍃My mom is my main source of support. She supports me in running my blogs and instagrams and this 100% because it helps me SO MUCH to focus on others and their needs. My therapist feels the same. And yes, he's read at least parts of my blog. He knows what I say. He thinks this is positive step for me, too. And trust me, he is a Magical Unicorn. I trust his judgement.

🍃You are free to disregard any or all advice I give. You are free to call me a hypocrite. You are free to feel your feelings.

🍃My sole goal in life is to help others. I feel this provides me some small opportunities to do that. This doesn't mean I define myself by my disorders. It means I define myself by my burning desire to take the yuck inside me and use it for something good. To some it may look like I just like obsessing about being sick. I don't see it that way. I'm obsessing about ways to help those who feel similar to how I feel because let's be real; it's an AWFUL way to feel.

🍃I am in "recovery". That doesn't mean weight gain at this stage in my journey. That's between me and my treatment team. You don't have to agree. But I am under the care of a clinical psychologist [and GP but that's a bit iffy]. I trust him. That's all that matters.

🍃You are free to challenge me. Call me out. Point out flaws in my logic. My therapist tells me I'm full of shit at least once a session, lol. I'm not afraid of criticism. If you have something to say, say it.

🍃Inpatient is not an option for me for reasons I've discussed at great length.

🍃I am human. I make mistakes. I say the wrong thing. All you need to do is point it out and I will do what I can to rectify it.

🍃You can ask me anything but I reserve the right to not answer questions that make me uncomfortable. I also reserve the right to not explain why if that causes discomfort too. But generally, I answer everything except specifics on my calorie count or weight or bmi.

🍃I hope I can help even one person feel less alone in this world. As my favourite multitalented man likes to say, You're not alone. We all go through the same shit. And there's always, always hope. 

Title lyrics: People Help the People by Birdy


A Play ~

I wrote this last year. It's on my old blog. Many of you probably read it already, but I found a bunch of these 'plays' on my phone in my drafts so I thought it might be good to keep them all in one place as I'd like to post a few more of them. 

This comes with a trigger warning for eating disordered behaviour.

Originally written and posted here on Aug 16, 2016.


ACT ONE

The curtains rise. A girl sits in the waiting room of her therapist's office. Her name is T. She is wearing clothes that are several sizes too big for her but the fabric is still pressing against her and reminding her that she is fat fat fat. She is crying already but she doesn't know why.

Her therapist enters. His name is M.

M: Hey, T. Please come through.

She rises. Unsteady. She doesn't look at him or wait for him as she stumbles her way into his office. She grabs a handful of tissues before she sits down. Her eyes continue to leak.
He enters the room. Closes the door. She can feel his eyes on her. She grips the scarf she is using like a shield against her chest and says nothing.

M: Hey. Hey now. What's wrong.

T: Searches for her voice. Fails to find it.

M: What's happened?

T: Error 404: Voice Not Found. Tears, however, have been located. The source of the eye leak is unknown.

M: T?

T: Curls over and pretends she doesn't exist.

T, internally: Just make words happen just make words happen oh my God just make words happen.

This continues for several minutes until finally...

T, barely a whisper: I don't think I can speak today.

M: I can see that. How long have you been this anxious for? When last did you sleep? When last did you eat?

T: I don't
I don't
I don't
know

M: Okay. It's okay.

Silence.

M: Do you know why you're so anxious?

T: Leaks harder. Claws the skin off her arms to make the leaking stop. Her arms start to bleed. It helps, a little.

T: I am...I think I am...I am angry.

M: Why are you angry?

Silence. She reaches for more tissues. Her hair shield is wet and gross and plastered to her salt water covered face.

T: I am angry at me.

M waits. She knows this dance. She has to fill the silence.

T: I am angry at myself. I am angry that I texted you last week. I am angry that I went to see my dietician anyway after all that. I am angry at my weight. I am too big and fat and ugly and disgusting to be out in public. I feel...I feel...

Her voice disappears again.

M: You saw your dietician? I didn't think you would.

T: Nods.

M: How did it go?

T, with the volume turned way down: I...I... I told him that I don't see why I should I continue to see him. I told him that I am wasting his time.

M: What did he say about that?

T: He said that it is his choice to make.

M: Laughs.

M: Does that sound familiar?

T: Yeah. I hate you both.

M: Laughs more.

M: What else did he say?

T: He said that I need a higher level of care. That I need to be in hospital or residential treatment and that he is taking steps to make that happen.

M: Did that freak you out?

T, Counting. Counting. Counting. Clawing. Clawing. Clawing: No. He's been saying that for a long time now. I don't think he can make it happen.

M: Silence. Then,

M: Do you think you need a higher level of care?

T: No. I'm fine.

M: You're not fine. You know my stance on things, yeah?

T: Nods.

M: I would love to see receive a higher level of care. I would love to see you get some more help, which isn't about punishing you or hurting you. It's about keeping you safe. We need to keep you safe. We need to get your weight back on track so we can work on the other things.

Counting. Counting. Counting.
Her hands are wet and dirty.
Dumb animal husbandry.

M: Was it as bad as you thought it would be, seeing him?

T: Yes.

M: Laughs.

M: What made you decide to go?

T: I spend so long being so afraid of it that I just wanted to get it over and done with.

M: What made it bad?

T: This is going to sound dumb but he looks at me a lot. I know that is his way of trying to gauge what I might weigh and how much weight I've lost since I refuse to get onto the scale, but I don't like it. And he touches me.

M: He touches you?

T: Yeah. Like my hands and shoulders. He says it's his way of gauging my level of oedema and muscle wastage.

M: Does he ask your permission?

T: No.

M: And it freaks you out?

T: Yes.

Silence. The plumber inside her head has fixed her eyes and they are no longer leaking. He has built a dam.

M: Is there anything that I do that freaks you out?

T: Silence.

M: It's not going to offend me. It would help me to know so I know how better to help you.

T: Well. There is one thing. But I don't want to say it.

M: Come on.

T: I can't.

M: Please?

T: I wrote the thing you asked me to write last week. I wrote about it in there.

M: Did you bring it?

T: Yes.

M: Can I read it?

T: Removes phone from pocket. Unlocks it. Hands it over.

M: Thank you.

There are several minutes of silence. T tries to disappear into the chair. The dam behind her eyes breaks and floods the room. Her voice leaves the building.

M: Did this all just come spewing out?

His voice is too far away to reach her. She is gone, gone, gone.

M: This isn't a criticism -- what you've written is fantastic -- but did you realize that it changes part of the way through? You go from being the therapist to just disclosing.

She is gone, gone, gone.

More silence. The audience is uncomfortable. Sometimes M asks questions. Sometimes M swears under his breath. T cries. And cries. And cries.

M: You brought it back. Fantastic. You wrote that it wasn't the girl's fault. Which part of that is bullshit?

T: No words no words no words.

M: Can you name the emotion you're feeling right now?

T: No words no words no words my lips taste like salt salt salt. I am sticky.

There's a knock at the door. M gets up. Thanks the person on the other side. Sits down with a blue blue blue mug in his hand.

M: Do you want a coffee? Black no sugar?

T: No words no words no words but I can shake my head. I think. Maybe. Okay. I can.

M: How many calories?

T: 2.

M: Laughs. Falls silent. Watches T as she vibrates a hole in the floor with her endless shaking.

M: Can we do a grounding exercise?

T: Does as she is told. Her words come back. The dam is in pieces. The plumbers try to fix it but it is useless unless useless. Her eyes leak the entire time. So does her nose. It is disgusting.

M, later: Can you tell me what you're feeling?

T: Well my eyes won't stop leaking.

M: That's called crying.

More time passes. More time than is hers to use. More time than he should be spending on someone as worthless as her.

Her eyes continue to leak.

M, later again: Did she really say that to you?

T: Yes.

M: What a fucking bitch.

More time. More silence. More leaks. They are drowning, by now. Surely they must be drowning.

Her heart hurts.

M, much, much later: Have you had enough for today?

T: Nods. Rubs her bloody fingernails on a tear stained tissue. Keeps her hands under her ScarfBlanketShield so he doesn't see.

M: Hey listen. Did you know that this is one of the few times that you...I'm not going to call it crying because I quite like the term Leaky Eyes. Did you know this is one of the few times that you've had leaky eyes in here?

T, still leaking: Is that a good thing?

M: Yes, because it means that you're connected to what's happening. You're working through it. The last few sessions you've shown real progress in terms of starting to work through this stuff.

T: Is mute.

M: Is lovely.

T: Leaks more.

M: Is still lovely.

The curtains fall.

END OF ACT ONE.


ACT TWO. HOURS LATER.


The curtains rise.

T: Is still leaking.

T: Is on the treadmill.

T: Has 197 calories inside her and has decided that's enough. That's enough now.

T: Needs a plumber.

The curtains fall.

END OF ACT TWO.