So I lead an isolated life …. what’s so bad about that?

Well, perhaps a lot … as it turns out.

Over the past few weeks I have been thinking about my behaviour a lot – so much so that I actually went to talk to my therapist about it. It’s the first time I’ve been to see her for about 18 months - I had stopped going because I felt like I didn’t have anything to talk about, but moreso that it felt self-indulgent to sit and talk about myself like that … anyway, I am not worried about my current behaviour, but I am interested to understand why I do what I do.

I’ll explain … I’ve noticed over recent years that I have become more and more socially isolated – and that’s by choice, not by bad luck or any kind of “poor me, I’m a victim of my disorder”.  During my relationship with Simon, as time went on I became estranged from most of my friends, primarily because I wanted to spend all my time with him and I wasn’t so motivated to socialise with my own women friends. Then when my relationship with Simon ended, although I kept up contact with several of my friends, I didn’t increase this contact – I didn’t feel a need to sit and “oh, poor me!…” or “oh, he’s such a bastard! …” with them and - as is the natural course of things because everyone is busy - over time the frequency of the get-togethers becomes less and less, until you realise that you don’t really see each other much at all. 

This building isolation has not really bothered me, but the part that does mystify me is that on the whole I just can’t be bothered making an effort.  It’s not that I fear social interractions – actually, when I do go out and meet up with a friend I usually have a lovely time – I enjoy chatting, having a glass of wine, a nice restaurant, good food etc.  It’s all really nice – or if I go away on a holiday, I go on my own but I always really make the most of where I am and have a great time.  But then  … if I don’t make that sort of effort, if I’m just at home I find I just don’t feel like doing anything social at all.  I just don’t have the strength, I would rather stay at home where my familiar things are, with my routine, my usual things to eat, my usual activities and my usual pattern of things – rather than trying something different. 

I flippantly describe my life in these terms … “most likely I’ll be one of those people who dies in their armchair at home and isn’t found until nine months later when someone breaks down the door because they can’t stand the stench any more and they need to find out where it’s coming from” … for some this may seem a horrific notion, but it doesn’t frighten me – and I rationalise it to myself by thinking “well … chances are high that it will happen, but I won’t know, will I? - cause I’ll be dead! ..”

My therapist explains that this apparent inertia and lack of motivation is my way of sticking to my rituals (as my disorder dictates) and that subconsciously I do it instead of making any change (even a slight one) and risk the anxiety of things not quite going how I had hoped, or that I couldn’t quite eat or exercise according to the needs of my disorder.

She suggests that there’s good medical reasons for me to keep up the remaining social contacts that I still have – perhaps even build on these.  For me, it seems such an effort that I am not really that motivated to do … I would much rather just be with my usual things and am very comfortable doing that, I don’t get bored, lonely or fed up. 

She also suggests that research supports the notion that social interaction is good for a person’s health - that the sense of wellbeing achieved through positive social interractions actually produces some type of chemical reaction in the brain (a feel good chemical, like seratonin?) that the body uses and thrives on.  As positive social interractions cause the production of this chemical and regular production is good for the brain, it is therefore good for a person’s overall health and wellbeing.  Further, that evidence shows a person with good regular social interractions will actually live longer.

In her opinion, my lack of social interraction is just another way that I avoid change – she calls it “avoidance behaviour” and it is something that I automatically do, in preference to the potential of creating anxiety.  Yes, I can see the logic in that.

Well … perhaps these are enough reasons for me to try to keep up (or actually reinstate) a few of these activities?

I’m self-destructive …

I had a thought today – my outlook on life and my attitude to death is different these days. Since I got so close to death three years ago, as a result of exercise obsession leading to anorexia (I had a BMI of 16) and my heart was under so much stress, I have faced my own mortality.  I faced it then – at that time I was totally terrified – terrified of having a heart attack, terrified of collapsing and dying, terrified of my life ending …  But now – three years later – I’m not.  I still face it – that same situation – my BMI is now 18 and I still put my body through high stress and a lot of exercise that I know is too much for it … I live with a lot of muscle pain, body cramps and general discomfort … because of the treatment I put my body through … but does it frighten me now?  …. No. Does it make me want to change what I do?  … No.

Over the past couple of years I’ve developed a much more relaxed attitude to everything in my life. I think I’ve started to do the things that are real to me – and just not bother with the rest. I spend my time doing things I want to do … if I want to be active, I’m active … if I want to sit around like a slug and just sleep, I do that … if I want to socialise, I do that … if I want to travel and do exciting things, I do that.  The result of this is that I am mostly solitary in my life – I spend most of my time alone, I live alone and most of my friends have departed from my life – I don’t see most people any more as they have gradually just drifted away … even my family don’t contact me much, they all live in another country, I am the ony one who is here, so they don’t really have much contact with me.

It’s left me with this thought that I had today – you know what? I might die – I might die really soon … if I did die, so what?

I know I’ll be one of those people who dies in their home and nobody finds them for weeks and weeks - but that doesn’t frighten me or worry me, why ? because I’ll be dead – so I won’t know.

I think I’ve developed this relaxed attitude because I know that, so I just spend my time doing what I want to do – I don’t seriously plan for my future, but I never have – I just let things happen to me.

I might just die one day and nobody will know for ages – but I don’t actually care.

This seems backwards ….

A thought has just struck me … is this happening to me backwards?

What I mean is, it’s been over three years since my relationship with Simon ended – at the time I seemed to be a lot more healthy, calm and resigned to the fact that it was over and how I felt, than I am now.  At the time it happened, my overwhelming feeling was relief – I felt released, free and just exhilarated to be out of it … but I didn’t ever cry … not ever.  I never got mad, I never smashed or wrecked stuff, never sent any poison pen letters or made hateful phone calls … never did anything – just put it inside, I guess. 

In fact, these days I think about it a whole lot more. Truth be told, I spend a lot of my time these days going over all that stuff that happened and shaking my head, thinking “why did I put up with it all?” … of course, I don’t know the answer to that.  But this is a new one – perhaps I was so broken, shocked, traumatised, upset and heart-broken at the time that my brain just couldn’t deal with it, so it shut the whole thing out of my consciousness?

Maybe?  Perhaps I have only just “unwrapped” enough of all the trauma and issues inside me, that I’ve got to that point?

My theory is that the combination of the trauma of emotional issues in the relationship and then the breakup itself actually shattered me … into pieces – some pieces are bigger than others, but I do think I’m now in pieces.  Will they ever integrate again?

I heard today that it takes you half as long to get over a relationship than the entire duration of the relationship itself … perhaps that’s true for me? If that’s the case, I was just over 10 years with Simon, but then it took another 3 years to actually break up and disconnect from him fully (it only happened a couple of months ago) … so …. thirteen years in it – that means 6.5 years working through it all and getting back on an even keel, emotionally. 

Yes, perhaps it will take that long …..

I don’t recognise me

I know I’m still me, but who is this person that I’ve become?

Now I don’t seem to enjoy any of the things I used to love – and I never go anywhere in my spare time, I just sit in my chair at home. I never have the energy to do anything for leisure except get my exercise done and eat my food each day … I sleep such a lot and I just don’t feel like doing anything.  Apart from work, I hardly ever go out, I rarely socialise and I just don’t have any interest in doing anything I used to really enjoy.

Who is this person?  and where did I go?   Am I still in there somewhere?  Yes, I think so - because I still feel the same inside.  I have the same level of intelligence, same knowledge, same thoughts, same ideals, same memories, same basic instincts … but on the outside - my behaviour and my lifestyle … I’m nobody I recognise any more.

The strange thing is that I am aware of all this change – it’s almost self-destructiveness …. but I’m not concerned about it – I don’t feel any movitation to change it whatsoever.

It’s just how it is.

My own needs … my what?

When I was first diagnosed with anorexia and depression, I was sent to see a Psychologist to work through some of the issues, because the cause of my condition (rapid weight loss through exercise obsession) was presumed to be emotional trauma that resulted in ongoing anxiety and panic attacks.

So … I started to talk with her – and she was very good, I liked her and I was happy to work with her.  At first, I didn’t really think I had anything to talk about – in my own mind I knew I was not very well, but I had attributed how I was feeling physically to “age and stage” rather than to the results of my behaviour.  Anyway – when we started working together one of the first things she asked me about was my relationship with Simon.  Our relationship had ended about 12 months before and as we talked it was becoming clear to her (and to me) that the effect of that break-up and of some of the events leading up to that point were strong contributors to my condition.  Through a couple of sessions, we talked about some particular aspects and episodes in the relationship and how they may have affected me. Then she suddenly said to me … “which of your needs were being met by this relationship?”.

Well … I stared at her – blank – my mind was totally empty.  I had no answer to this question.  So she said … “okay, well if you are not sure about that, can you identify what your needs are?”

Again – blank – I had no answer for this either.  I didn’t have a clue – what are my needs?  … my needs?  … MY needs?  I didn’t know – I had absolutely no idea – I had never thought about it.

She suggested that I have a think about it between this and my following session to see what I could identify as my needs.  This was really difficult for me, it was like hard homework – I was actually worried about it. I had no idea of the answer whatsoever. I had never thought about it and I didn’t really know where to begin. 

I was worried – what if I came up with the wrong thing?  What if I thought I needed something but it turned out to be wrong?  I worried that I might lock something into my situation that wasn’t right – then I’d be stuck with it, perhaps working towards achieving something that wasn’t really what I needed … it was terrible.  I racked my brain trying to come up with what my needs are … I thought “this is ridiculous … how could I not know what I need?”  … well, it had been so long since I thought about myself in that way that I really had no idea.

To get the task completed by the next session, I thought about the things in the relationship that made me feel good, happy or enriched. The only things I could come up with were reassurance, credibility and identity.  That is, I wanted to feel:

• Reassurance - that everything is okay (or going to be okay)
• Credibility - that I matter
• Identity - that I know who I am and am happy with it.

I still don’t know if these are my real needs.  I can say that these things were not being delivered for me in my relationship with Simon. Through this process  I also learned a new word from  my psychologist - subjugate.  I had not known of this word before, but it is what I do - it means to be “readily submissive” -  for example a person will ”subjugate one’s own needs in favour of others’ needs” – yes, I had done that. 

I had done it so much that I’d forgotten that I could even have needs.

How does having an eating disorder wreck a social life?

I know that an eating disorder is often an obsession, compulsion or addiction (perhaps a blend of these things). I also know that many people who suffer from an eating disorder end up that way because they have experienced trauma or anxiety and they probably have issues with self-esteem, body image and needing to maintain control.  Also, I know that an afflicted person prioritises their chosen activity higher than any other part of their life – such as relationships, sleep, work, health or social life.

Okay … but what may not be so clearly understood is … given the afflicted person’s need for a life they feel is under control and where they get reassurance of their self-worth (this is me …) – why do they then behave so strangely in their social interactions, which results in destruction of their social life? (… this is me too).

Yesterday I was watching a show on television about male body builders and their obsessive behaviour. A person on that show had a great description of how this type of behaviour disrupts the afflicted’s social life.  He said … “When a person’s got an obsession with behaviour such as exercise, social occasions become very difficult because the afflicted thinks things like …..

If I go to dinner with these people tonight:

• I’m not going to be using my time well, I should be exercising …
• I’m not going to be able to get what I want to eat, then my exercise regime will be mucked up because I’ll either eat nothing, not enough or too much
• I’m going to have to miss an exercise session to do it
• I”m going to have to make up for the missed exercise at another time – probably double up on tomorrow’s
• I’m going to have to make up for the different food/drink I have had at some other time – maybe eat less tomorrow? – but I can’t do that because I’ll need to exercise double tomorrow to make up for today and will need the energy …”
• Oh it’s just easier not to bother.

Yes, these are exactly my thoughts.

Another thing is that this thought process, even when you try hard for it not to - is detected by the people around you and has a negative effect on the mood and the atmosphere at dinner.  My tendency is to question the serving staff about the dish (portion size, ingredients, cooking style, dressings etc) so that I can satisfy myself that the dish I am going to get won’t contain something I don’t want to eat.

… and that’s another thing about eating out – a customer at a restaurant has to have a good  level of trust that the dish they order is going to be what they want.  When does this happen in other types of purchases? … apart from some Japanese or Asian restaurants, you don’t get the option to “see before you decide” – the chance that you are going to be able to see the dish before you order it (like you would pretty much every other thing that you buy … technology, car, house, clothes, books etc – apart from entertainment and movies) – is remote.  Therefore you have to believe what the menu says, what the waiter says or what your knowledge says about the information you have about the dish – this is not good for a person with an eating disorder … hence all the questioning.

This can then turn a potentially enjoyable evening out into a bit of a disaster – particularly if you dine with the same people regularly – they get sick of it and wish you’d just “relax, chill out … don’t worry so much about it “ … again – it’s just easier to stay at home because you know where you are and what you’re doing then, there’s no doubts or concerns or unknowns.

The best outcome of this scenario is that you have to go somewhere where all the food is already on display – not great if you want something up-market – or you will actually find dishes at some restaurants that match what you need and you return to the same restaurant to have the same dish(es) over and over again.  This is not good for friends who probably don’t want this type of repetition in their social lives.

This is how my social life has become such a disaster and why it is basically non-existent these days.

Thin is in … it’s so far in, it’s never going to change

Before I could think for myself, the core instinct of my entire life (apart from the instinct to stay alive) was locked into my mind. It got locked so deeply within me that it will never, ever go away …

“The skinnier you are, the better ….”

That sentence doesn’t actually finish, because it’s all encompassing.  It means if you’re skinny you’ll have “better” everything … you’ll be happier, you’ll have better relationships, you’ll be more successful, more people will look up to you, you’ll be better at sport, you’ll be a better musician, you’ll win more prizes, you’ll be the envy of more people …. Yaddah, yaddah, yaddah ……

Yes, this is what I learned before I could even articulate it.  Where did it come from?  I guess it came from those influences around me – my family? my sister? my observations of the world?  Yes, probably all these things. I would watch the world around me and I remember the feeling of total envy at the teenage girls who were members of the club my family belonged to – these girls were happy, pretty, dressed well and … skinny.

Way back in the 1930′s, Wallis Simpson (Duchess of Windsor)  was attributed with a saying that has become very well known since … “a girl can never be too rich or too thin” … this is just something that resonates with me (well, the rich part doesn’t, but the thin part does). I can’t help it – it went in there and it’s not coming out.

I think a very strong influence on my thinking would have been my sister.  She was only a little (4 years) older than me, but the gap in years during our childhood was enough for her to experience every significant thing, long before I did. First kiss, first night out, first friends outside family, first period, first clothes she bought herself, first music she heard outside of family influence. All her experiences impacted on me strongly – I observed everything she did, just because I was there. 

I was a fat girl of 10 or 11 and she was a skinny teenager of 14 or 15. That meant that we were pretty much the same size at the same time, so as the clothes I wore were hand-me-downs from her, I wore them as soon as she handed them down, not four years later. I read her teenage magazines, listened to her records, eaves-dropped on her teenage conversations with friends and picked up on most of what she was saying. I first learnt about sex from her – by reading the books and magazines she had. I learned how to apply makeup by watching her do it, I learned what clothes were popular. I learned how to tend to my needs during menstruation from her, not my mother – and I learned that “thin was in” from her too.

To be clear here … I don’t write this to blame her, it is merely an observation of the influences in my early life.

There’s another key point to be made here about the influence of family … my mother was never one for fashion, nor vanity. She is very myopic, so she never developed the skills of applying makeup (because she can’t see without her spectacles), nor did she pluck eyebrows, apply lotions and potions to keep skin nice, or anything like that really.  She never even did hair – there was never a “girly night” with my mother – we never shared those things at all because she wasn’t interested and we never learned about it.  Add to this, we were a family (with my brother and father) living by very frugal means, so there were never any new clothes (apart from something bought for Christmas by Nana or Grandma). The result of this (a positive one) was that my sister and I never really developed any vanity - we didn’t spend hours in the bathroom or in front of the mirror, we didn’t know anything about how to do hair, never even owned a hair-dryer until we could afford our own and we never had any inclination for the newest, most fashionable clothes – until we saw our friends or others wearing them.

The only thing we did learn (and not really from my mother either) was that being fat was bad.  Through childhood, school, adolescence and early adulthood both my sister and I had stages of fatness, we both struggled with weight and we both spent more time being heavy than we did being light.

To this day, residuals from my close relationship with my sister are there … I clearly remember one day when she had heard that a friend of hers had been sick with a throat infection for a week and as a result her friend had lost six pounds. My sister’s first words about it were “Six pounds!  The bitch!”

As a teenager and in my early twenties, I spent a lot of weekend time with her in her own place –  I remember she had a magnet on her fridge that said “Thin is in …” and we spent a lot of time cooking good healthy “this won’t make you fat” things.

I have written before that my school friends (with the exception of one) were all very normal, healthy, average size. No issues of body image really came up in conversation with these girls. I am still friends with two of them now and I recently had a conversation with one that went …

She: “You’re doing okay at the moment, hey Ruby?”

Me: “Yes, but it’s always a fight for me to keep my mind straight”

She: “Why?”

Me:  “Because my mind goes back to all those mean things the boys in our class said about how fat I was”

She: “But you were never REALLY fat, Ruby – a little bit overweight, yes, but not extremely – nobody we knew was”

Me: “Oh, yes I was – I remember those horrible times in school really clearly”

She:  “No, Ruby, I don’t think so”

It seems my friends never had that impression of me – not then and not now. I think the fact that I have ended up with anorexia and exercise obsession is a bit of a mystery to them.

Now, as adults, my sister and I have developed different views about being fat.  My sister has “grown out of it” … she’s developed a mature attitude to her health that is basically “well, I’d rather be healthy and happy, than skinny” and that’s the way she lives.  I, on the other hand, have not developed such a healthy approach to my body … as you know.

So, it’s in me – the discipline, the tenacity and the utter determination to push my body to the limit every single day so that I don’t get fat – it’s all just inside me.  And it’s not going anywhere.

Is this depression?

I’ve been thinking about this … depression seems to be such a widespread and commonly diagnosed condition in our society today … what does it mean?  what does it mean for me?

Do I experience what I have read as the “key signs” of depression:

1. Constantly feeling down or hopeless – Down? no … Hopeless? well … I feel this occasionally perhaps – but not “constantly” and not to an extent that I don’t want to do anything or that I feel it’s not worth doing anything, so overall – NOT REALLY.
2. Having little interest or pleasure in doing things you used to enjoy … Yes, I relate more to this one – I used to enjoy going out, socialising, eating out, dancing at clubs, drinking and parties.  But I don’t feel like doing any of these things very much at all any more – there is no pleasure in it for me. But that’s because of my eating disorder – these days, I avoid most social situations because they will involve eating and/or drinking – and eating at a restaurant can become such an anxious time that I usually restrict myself to restaurants I know will have something “acceptable” to me.  If I ever eat with a companion, I try for it not to become an issue when we eat out, but it might be for them.  So for this one, I suppose I would say … YES, I feel this.

Then there are other “possible” signs that may point to depression

1. irritability or restlessness, feeling tired all the time, or general loss of energy – mmmm, no not really.  I’ve always been a “difficult” person, in that I don’t make it easy for people to get along with me, so that’s nothing new. Restless .. perhaps, in that I can’t really focus on one thing (particularly reading) for very long, but not fidgety. Sometimes I do feel like I’m being erratic and jumping about from one thing to the next without finishing things off.  Tired … nothing that wouldn’t be solved if I didn’t have exercise obsession. General loss of energy – no, not really. So, overall - MAYBE for this one. 
2. Feelings of emptiness or loneliness – no, not really.  I do live a solitary life - by my own choosing.  I have no partner, very few friends and I don’t socialise often, but I don’t feel lonely or that I have an empty life.  Yes, sometimes I do think “hmm, what shall I do with my time?” … but it’s not long term or chronic emptiness or loneliness.  So this one is a NO, NOT REALLY.
3. no longer interested in favourite activities – no, I still love music, movies, travel and still eat out when I can (see above). NO, NOT REALLY for this one.
4. Sleep problems – too much, or too little. Yes, maybe – both ends of this spectrum.  I sleep a lot during the day – but I have explained this because I exercise so much and I need to rest.  Also, I am awake through the night sometimes.  So for this one, although I wouldn’t classify it as a problem, I’d say it’s a YES.
5. Weight loss or gain – well, yes – weight loss, obviously – caused by anorexia through exercise obsession.  YES.
6. Low self-esteem – I can’t really tell.  I don’t think so, but others may have a different view on this.  I am not objective enough to say.  So perhaps it’s a MAYBE.
7. Problems with concentration -  well sometimes.  Not when I am working – when my brain is fully engaged on a task, I’m productive, lucid, rational and quite fine to do my job (that does involve strategic thinking and brain work), but in my personal life, not so much … see my comment about reading above.  So here perhaps another MAYBE.
8. Reduced sex drive - absolutely.  I have nothing active nor any impulse there whatsoever.  YES.
9. Thinking about death a lot – no, not this one at all.  NO
10. Anxiety - I have always been a worrier, but I don’t think I worry about things more than usual.  However, that is now – when I was in full anorexic crisis I was beside myself with anxiety about everything, particularly eating and exercise. I did suffer panic attacks and some physical symptoms like breathlessness, a pounding heart and stomach cramps.  So, to be fair, I’d say YES, for this.

Okay, so how is my scorecard?  Of the ‘Key’ factors, I score 1 YES out of 2.  Of the ten ‘Possible” factors, I score 4 x YES’s, 3 x MAYBE’s and 3 x NOT REALLY’s. 

Hmm, okay – so that does seem likely that I have depression then, doesn’t it.

Listen to your “positive” internal dialogue

Everyone has internal dialogue – we may call it different things … “my mind” … the “voice(s)” …  “something inside me” … but however it appears to each of us and however we perceive or describe it, we all have it.

Internal dialogue can work for you or against you.  My internal dialogue is my own voice and it’s in my head, I hear it clearly and I speak back to it sometimes - either internally or I speak out loud externally to it …. (this doesn’t seem quite so insane if you live on your own, like I do!). 

For most of my life, my internal dialogue has worked against me … it always gave me negative messages by reminding me of negative things …. such as …. why I don’t derserve something … or why that doesn’t look good on me … or why I continually fail at something I try …. or why I’m fat (I still have that one, actually) …. or it would keep “replaying” to me the things that others had said to me that really hurt me or made me feel terrible or not worthy (oh yeah … I still have this one too ..) … remember too, mostly others only say something once to you – they only need to say it once for it to hurt you and cut deep, but your  internal dialogue will pick it up and repeat it to you endlessly, hurting you over again every single time.

You can actually control this part of you and make it a positive and valuable tool in your life.  I found that if I just accept that my internal dialogue will be there and it will say stuff to me, no matter what else is going on … I might as well work on making it say positive things to me, instead of continuous negative things.

So I started to treat it differently … for a start, I accepted that it was there and part of me – not some subconscious alien thing that I had no control over and didn’t know what it would do next … then I decided that I wanted it to say positive things to me …..

They only have to start small, but you can get your mind to repeat good stuff, instead of bad stuff to you – so it might be something like a line in a song or the words to a song that you really like or that really speaks to you? … or when someone once said something nice to you, can you bring that to mind now and repeat it to yourself?  … do you have a mantra or affirmation that you think is usfeul that you can repeat to yourself, like “today is here, I can breathe and I am alive – that’s really good” or “I’m going to smile right now” … or “what a beautiful day!”

This will be enough to start you feeling positive – when that happens, remember how it feels … remember the warm sensation you get inside and know that you want to feel that again and feel it more  … then each time one of your “bad” dialogues starts to raise itself again and you start to feel anxious or frightened or low, you can summon up one of your positive good thoughts and bring that feeling to yourself again.  After a while you’ll get used to calming and reducing the impact of the negative thing so that it gets impotent - this is a good step in your development of better positivity.  If you think about your negative dialogue a bit like a poison inside you, you can dilute it until it will eventually not have any bad effect on you.

I’ve practiced this and for the most part my dialogue now says things to me like … “hey, good job -you walked as far as that today …”  or “good effort, that workout went well”  … “your hair looks nice today …” or “what a gorgeous day to be alive, I’ll make sure I really acknowledge that” …  I know, it sounds really corny and insane – but give it a try, you might get used to it!

Sick? .. yes; Stupid? … no

In the three years that I have been receiving medical treatment since my diagnosis with anorexia and depression, I have encountered a recurring frustration with the professionals I am working with.  They treat me as if I’m stupid …

I think this is a valuable lesson for medical professionals – just because a person is sick, it doesn’t mean they’re stupid. 

In my own case, I developed anorexia because I made a fundamental error of judgement about what was a sensible and healthy way to eat and what was an accompanying sensible and healthy level of exercise.  But that’s all … yes, I was living my life using guiding principles that were flawed … but … that doesn’t render me completely incapable of rational thought, logical reason or sensible judgement.

I don’t need a doctor protecting me from the bald facts of anorexia and trying to ‘sugar coat’ the risks of sustained malnutrition – I am an adult, I can take it – how else will I make a rational decision about the best way to approach and fix this problem, if I don’t know the truth?

I don’t need a doctor patronising me with “well, I’m the Doctor – I say you will do this – Doctor’s orders, so you will do this … and you will do it without questioning me” … Um, no actually, Doc -  this might be hard for you to hear, but I’m an adult, so I’ll decide what I’ll do and what I won’t do … not you.  Furthermore, if I have a question about your treatment, your methods or your evidence to support your decision making, I’ll ask you – and I’ll expect you to tell me.  There are two adults in this – you and me.

I don’t need a doctor speaking to me in “words …. of …. one … syllable ….” to make sure I understand – I’m smart, I get it, okay?

I don’t appreciate a doctor (who is a self-confessed novice at treating adult anorexia) … sitting at her desk in her rooms telling me “well – of course, if you start running, you’ll never stop … because you’re addicted to it …”   – Oh, come on, lady!  How stupid do you think I am?   

I don’t need a doctor asking me the same question over and over again – “are you running, Ruby?” … “have you started running again, Ruby?” ….. “is running part of your exercise program now, Ruby?” ….. Hey, Doc – it’s been asked and answered the first time, 0kay?  …. how many times do I need to say no for you to believe me?

Yes, I’m sick … but I’m not stupid.