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Did my recovery experience have to be so tortuous? Could the diary help?

September 17th, 2016

Did my recovery experience have to be so tortuous? Could the diary have provided a more pro-active role in healing? I wanted to find out.


Above all, the catalyst for my book The Diary Healer was a desire to explore and reveal the potential of diary writing as a therapeutic tool in self-renewal and healing.
The story behind The Diary Healer began in 1962, when I developed an eating disorder and began to keep a diary. I was 11 years’ old and did not understand why I was too afraid to eat, or why I could not sit still.
My frustrated mother, unaware that my head was filled with bossy thoughts and compelling fear, criticised my behavior and compounded my guilt. I retreated and became withdrawn. 
Then, for Christmas that year, the gift of a diary provided a reprieve.
Becoming what seemed an immediate, trusted friend, the first little book marked the start of a literary journey that, over the next 40-plus years, would chronicle the loss and recovery of my identity and self.
My healing journey took a long, long time – more than 20 years. When I healed sufficiently to be free of the eating disorder, I began to wonder about the influence of the diary in the reintegration of ‘true me’. Did my recovery experience have to be so tortuous? Could the diary have provided a more pro-active role in healing? I wanted to find out.
Writing a memoir [A Girl Called Tim, 2011] had helped to place the illness in the context of my life and to relate with others. Reader interest motivated and inspired me to delve more deeply and learn about and explain the pitfalls and benefits of diary writing. I began to explore the ambivalent relationship with body and identity that can occur when experiencing an eating disorder.
 So began the concept for this book.
using-writing-as-a-therapy-for-eating-disorders_fawIn 2014, shortly after Routledge offered a contract for Using Writing as a Therapy for Eating Disorders – The Diary Healer, I also received the offer of PhD candidature in Creative Writing, at Central Queensland University, Australia.
Excitingly, this opportunity enabled The Diary Healer to become the creative work in my PhD.

Read more here.

 

An Enduring Relationship: the Patient and the Therapist Who Does Not Give Up

August 26th, 2016

Screen Shot 2016-08-26 at 6.55.00 PMI was thirty-two, suicidal, and trapped in a self-destruction spiral when I met the psychiatrist who would save my life. I had developed anorexia nervosa at age eleven and the illness was embedded in my brain. ‘Prof’, as I called him, won my trust, saved my life. My therapy had no name. What mattered was the psychiatrist-patient relationship. Prof believed in me and I believed in him and this made all the difference. Our therapeutic relationship began in 1984.

Prior to meeting Prof, I worried he would conclude there was nothing wrong and confirm I was an incredibly inadequate person. Other doctors had tried their best but, through misdiagnosis, my struggles had got worse. More than two decades had passed since I developed anorexia.

I had received no professional help during this time. I had survived by transitioning into anorexia-bulimia. Prof asked me to fill out a lengthy life history.

Screen Shot 2016-08-26 at 6.52.21 PMI described my childhood which included early identity confusion (e.g. my mother called me Tim when good, Toby when bad); and how puberty onset at 11 sparked intense anxiety and anorexia nervosa, leading to self-harming, and disconnection of body from self.

Screen Shot 2016-08-26 at 6.48.30 PMMany of the effects of starvation on my body in childhood diminished when adequate nutrition resumed in my mid teens. However, some effects of prolonged malnutrition on my brain continued into adulthood.

I was ready to conclude I was a hopeless case. However, within minutes of meeting ‘Prof’, I knew he could help me. He ‘saw’ me, beyond the layers of the eating disorder, and confirmed an illness in my brain. I definitely, immediately, felt relieved. I was not simply weak-willed after all and perhaps, with the right help, I could heal. However, beyond the initial euphoric moment, fear swept back in.

‘You have never been helped since developing anorexia,’ Prof said matter-of-factly. He suggested my private diaries, kept since the illness developed, might help to sort my problems.

You’re not to give up hope

At my second appointment, Prof provided the first accurate assessment of my illness. He confirmed I had developed anorexia nervosa, transitioning from restrictive type to binge/purge, and described my level of functioning as ‘fair’. He observed: ‘Your life has been full of anxiety and depression.’ ‘You are a ‘chronic case’.’ There was no quick fix. The enormity of this struggle hit me as I left Prof’s consulting room that second day, clutching a prescription, the first of many over the next several decades. However, on my next visit, Prof said:

You’re not to give up hope. You’ve had the illness more than 20 years and it will take time to get well.

I told Prof how I had four children in four years, each pregnancy becoming a desperate bid to suppress the eating disorder, and how, at age 28, and suicidal, I was driven to share my inner struggle with doctor for first time.

Acknowledging that thoughts and behaviours, which for decades had seemed helpful, if not absolutely essential for survival, must be jettisoned because they are harmful, was beyond scary. How could I face the challenge of accepting that my structure of self, to which I had devoted and sacrificed many hours of each day, since childhood, was false and deceptive? That my thoughts were not authentic? That instead, these thoughts were symptomatic of a brain-based disorder? Who was I????

Getting ‘me’ back
Screen Shot 2016-08-26 at 7.03.58 PMProf was leader of a small team in whom I developed trust. He set about helping me unearth and confront the layers of illness—interlaced with secrets and shame—that were suppressing the true me. Visits to Prof took on a pattern.

I would arrive with pages of notes. He would read my ramblings, look at me, ask questions, offer guidance, and check prescriptions. He believed in pharmacological solutions. The medications slowed my illness thoughts, allowing time for the gradual restoration of self-belief, chiefly through the method of written communication. Prof understood that I felt safer writing what I didn’t yet feel able to voice.

In this way, my personal diary provided a conduit through which we built a trusting relationship, a vital first step in reconnecting with self.

The path was not always rosy. Interpersonal relationships had suffered throughout my illness and continued to do so. My complete family of origin and my marriage were lost, but my life was saved.

Going forward required a total re-make; a reintegration of various frayed or lost strands of the true ‘me’.

Besides overcoming fear that accompanied regular eating, I faced the mammoth task of locating and re-integrating fragments of self into a sound foundation, from which to venture forth and re-engage in life. I had to let go thoughts, behaviours, and relationships that fed my illness, and develop healthy thoughts and behaviours.

Post divorce, I became drawn into unhealthy and chaotic situations and relationships. The eating disorder bully had been part of my life for so long that being kind to myself and keeping myself safe seemed foreign. Consequently, when starting to feel settled, I would seek fresh and familiar sources of chaos that aligned with the eating disorder traits. Prof would patiently offer encouragement:

It is not that you are wrong but that (solution or person) is not right for you; keep trying.

The therapeutic alliance – bridges of trust
The authentic me slowly learned how my decisions, sometimes in the name of staying “in control” and being “good,” were maintaining my illness. To be free, I had to develop a new approach. Drawing on my diaries in writing letters to Prof helped me to edge forward in recovery.

From this tenuous leap of faith in the direction of Prof, I began slowly to trust and connect with true ‘me’. With encouragement, I began to read through earlier diaries and reflect on them. This involved re-visiting painful and traumatic times. Addressing layers of suppressed emotion was a prerequisite for escaping the eating disorder’s grip and constructing a safe base of self-belief. As well, on-going physical health issues needed to be addressed.

Prof knew that he could only do so much: to be free I had to reach the point where I could transform my belief and trust in him to belief and trust in myself.

Screen Shot 2016-08-26 at 7.02.51 PM2006 was the first year in more than four decades not dominated by my eating disorder. I was eating regular and nutritious meals, no longer slipped into deep depression and was learning to manage residual anxiety.

Able to function and engage more in the mainstream, Prof encouraged the writing of my memoir, A Girl Called Tim, released in 2011.

What mattered most during my treatment with Prof was not the treatment so much but the level of trust formed between therapist and patient. Just knowing he was there, was helpful. He was an anchor, a safe person with whom to share the inner hell that I had lived with alone for decades; and he became the sounding board for the emerging authentic self.

He patiently taught me techniques to strengthen authentic thoughts. If feeling confused, or confronting a problem, today I automatically think ‘Action beats anxiety’ and, in decision-making, I ask, ‘What is in my best interest?’ If feeling unworthy, or experiencing self-doubt, I remind myself to stand tall and own my space, for ‘I deserve to be treated with respect’.

Accepting that ‘life is not fair’ is liberating
I had been expecting life to be fair; indeed, often doggedly insisting it “should be”. It wasn’t. It took time to appreciate Prof’s understanding that my getting hung up on an issue, because it ‘wasn’t fair’, or clinging to a relationship that was unhealthy for me, served only to strengthen the eating disorder’s hold, giving it yet another ‘reason’ for me to binge or restrict, or engage in other self-harming behaviours. When I pushed aside the eating disorder’s interpretation, and absorbed the meaning behind Prof’s words, inner healing took another step forward.

Somewhere along the way I said to Prof: ‘I’ve got my life picture sorted now’. He said: ‘No, you haven’t’. Again, he was right. I know now that life is like a never-ending jigsaw.

New pieces continue to appear, requiring adjustments to the picture in an ever-enriching and healing way, as long as life itself. Thank you, Prof, for not giving up on me.

Screen Shot 2016-08-26 at 7.01.44 PMIn the ten years since reconnecting with true self, I have written nine books on eating disorders. They include my memoir A Girl Called Tim, and latest book, Using Writing as a Therapy for Eating Disorders – The Diary Healer which is the creative work in a PhD in Creative Writing with CQU Australia; I also contribute a chapter from the patient’s perspective in ground-breaking book Managing Severe and Enduring Anorexia Nervosa.

  • This exploration of an enduring physician-patient relationship is a tribute to the late Professor of Psychiatry, Graham Burrows AO. Prof Burrows died in January 2016, aged 77. Prominent in Australian and international psychiatry, he was my psychiatrist for 30 years.
  • This article is an edited version of the paper, An Enduring Relationship: the Patient and the Therapist Who Does Not Give Up, co-presented with Professor Stephen Touyz at the 14th annual conference of the Australian and New Zealand Academy for Eating Disorders, Christchurch, New Zealand, on August 26, 2016.

 

Diaries, grief and healing – through the eyes of a new book

July 30th, 2016

Grief Diaries-2016A vital element in healing from a mental health challenge is to know we are not alone. This is particularly so when experiencing an eating disorder, an illness which by its very nature encourages secrecy and promotes isolation. In seeking to heal from an eating disorder, it helps to know that others have felt like we are feeling and, to learn that they have healed, helps us believe we can heal, too. One of the best ways I know, for learning and discovering more about our illness and gaining inspiration to strengthen our true self, is through story-sharing.

You might think that a ‘Grief Diaries’ book, by its very title, will be essentially a morbid read. Wrong. Lynda Cheldelin Fell has created an amazing series,  through the narrative of diary writing, on some of the many ways grief can touch our lives. Each book, while being open, candid, raw and to the core, is equally  heartwarming, uplifting, courageous, comforting and motivating.

Lynda Cheldelin Fell, through bravely sharing her story, gives others permission to also share and reveal their stories …

I believe, through sharing our stories (about those inner secrets and thoughts that have kept true self a prisoner, often for decades) in a supportive environment provides a safe way to help break down the internal and external barriers of stigma and shame that frequently accompany mental health challenges.

For this reason I am delighted to be a co-author of, and contributor to, Grief Diaries: Through the Eyes of An Eating Disorder.

 

Announcing: the birth of The Diary Healer

July 26th, 2016

Using Writing as a Therapy for Eating Disorders_FAWI am delighted and excited to announce the birth of my book affectionately known as The Diary Healer…

I am deeply grateful for the many generous contributions, together with ongoing assistance, guidance and encouragement in the creation of this book, a three-year journey which has led to many friendships being formed, and in the process, the wonder of much healing taking place. Thank you also, tony publisher Routledge (London) for believing in this book concept from the start.

My wish is for this book to help promote writing as a therapeutic tool in the treatment of eating disorders.

For more details: see this Routledge link

 

Wanted: 100 research participants to compare anorexia nervosa types

June 20th, 2016
Katie Linden

Katie Linden

Young UK researcher, Katie Linden, needs your help, fast! She wants to gather 100 participants before the end of July to assist her investigation on whether people who have experienced anorexia without body dysmorphia show the same local processing bias as people with more ‘typical’ anorexia.

Here is the link.

To help interest you in taking part, Katie answers some questions:

Who can take part?

You can take part if you have a current or historical/past diagnosis of anorexia nervosa, including atypical anorexia nervosa. You must also be over the age of 18, and have no visual impairments that cannot be corrected with glasses or contact lenses, and have a BMI over 16.
I’m particularly interested in comparing the responses of people who have experienced non-fat phobic anorexia. with people who have experienced more ‘typical’ anorexia that involved body dysmorphia.

What do I have to do?

You will fill out a few demographic questions, a questionnaire on processing styles, and complete a brief cognitive task. This part of the study should take around 15 minutes. If you are willing to provide your email address, a further cognitive task will be emailed to you which will take another 15-20 minutes.

It is very important that you complete this study on a computer with a keyboard (desktop, laptop, or notebook) rather than a tablet or mobile phone, as one of the cognitive tasks requires you to press certain keys, and this may not be recorded accurately on a touchscreen.

What is involved?
The research involves some questions about you (age, gender, which type of anorexia you have had, etc), a questionnaire and two computerised tasks which assess certain aspects of the way your brain processes information.

What outcome do you hope to achieve?
There has also recently been debate over whether anorexia without body dysmorphia is a legitimate type of anorexia, or whether it should be classified as something else. This research is designed to see how the two types of anorexia compare on a cognitive level, to help determine whether they are the same or different types of eating disorder.

When do you need to hear from respondents and when do you expect an outcome?
The research will run until the end of July this year, so it will be great if you can take part as soon as possible. I will have the responses analysed and written up by mid-August, and anyone wanting a basic summary of what was found can request one via email.

Why are you undertaking this research?
I’m partly motivated to investigate this topic because non-fat phobic anorexia is very under researched. Cognitive processing style has been studied extensively in anorexia in general, but the only study that has looked at differences and similarities between subtypes looked at restricting versus binge/purging anorexia, so my study hasn’t been done before. I also have personal experience in this area, as I’m in recovery from non-fat phobic anorexia, and I know of several people who have struggled in treatment because they felt like clinicians were trying to squash them into the box of ‘typical’ anorexia when it really didn’t fit. All of this tells me that we need to know more!

Where are you based?
I live in Newcastle upon Tyne, in the North East of England, and my research is being conducted as part of an MSc Psychology at Northumbria University.

BACKGROUND

Katie shares this interesting background to her research – it makes me think that the search for effective treatments for eating disorders is in good hands as new generations of researchers enter the field:

Most of you will know about the links between anorexia and autistic spectrum conditions, in that both conditions seem to share a common cognitive profile: difficulties in social situations, rigid adherence to rules and routines, and detail focus at the expense of the bigger picture. Detail focus is otherwise known as weak central coherence, or a local processing bias, in research.

The usual ‘default’ in the general population is a global processing bias – you look at a whole scene first, then focus in on details – whereas people with anorexia and autism tend to see details first, and to get stuck there. Some authors have also suggested that getting stuck on details may give rise to poor body image in anorexia – along the lines of, if you are only looking at tiny areas of your body rather than processing the global whole, everything would look out of proportion.

This is part of the rationale for novel treatments like cognitive remediation therapy, which focuses on altering cognitive styles – like a local processing bias – rather than cognitive context – like “I’m too big and it’s intolerable”.

My research will  look at whether people who have experienced anorexia without body dysmorphia show the same local processing bias as people with more ‘typical’ anorexia. If a local processing bias is only common to people with body dysmorphia, this might suggest a causal link, whereas if people with anorexia without body dysmorphia share processing styles, it might be that processing style is a more general risk factor for developing/maintaining anorexia, and body image disturbances are just one possible symptom of this.

Reasons for the focus on anorexia

  • I have deliberately chosen anorexia as the focus of the study as there is an extensive history of, and body of research into, anorexia without body dysmorphia (non-fat phobic anorexia), in comparison to the absence of body dysmorphia in other EDs. As this is just a year long project I had to be a bit narrow in my focus.
  • I’ve also asked about subtypes of anorexia rather than ARFID versus anorexia as I genuinely believe, and think I have a fair amount of evidence to back this up, that anorexia can exist without body dysmorphia.
  • In ARFID there isn’t a fear of weight gain, restriction is based on sensory issues or past negative experiences of food like choking episodes. This still leaves a gap in the DSM, because it is quite possible for people to be terrified of weight gain itself without the ‘reason’ being body dysmorphia. Showing a common cognitive profile between subtypes of AN would strengthen the argument that anorexia needs to be seen as a more diverse condition, rather than those experiencing anorexia without fat phobia being subjected to suspicious clinicians accusing them of lying.
  • One of the demographic questions in the first part of my study asks for the participant’s weight. This is because low weight can heighten detail focus, and while I ideally want people to be able to classify themselves as recovered or currently unwell, there is a tendency for some people to insist it is perfectly possible to be fully recovered at a BMI of [insert unrealistically low thing here], and I need to control for that somehow.
  • Likewise, the ethics board insisted that I not use anyone with a BMI under a certain point due to issues around informed consent. If you or anyone you share this with is uncomfortable with sharing weight, either don’t answer that or alternatively, I’m not going to know if you/they make a number up.
  • Who should I contact if I have questions about this study?

Contact the researcher, Katie Linden, if you have any questions about this study (katie.linden@northumbria.ac.uk)

This study and its protocol received full ethical approval from the Department of Psychology Ethics Committee in accordance with Northumbria University and governance regulations.