Reframing: ED as AN + OCD

So I came to conclusion, probably part of the grief process. Woke up feeling push-pulled through the time she had left. Doubt, guilt, should want to do this or that. Should want to go on a road trip, should want to buy a different house.

All these shoulds represent going against one’s own nature. I felt uncomfortable doing things, thinking I should want to do things–travel, visit, socialize. In my heart of hearts I wanted to remain open to paying attention. I wonder if it is part of agoraphobia? I don’t like earphones, headphones, movies, concerts, TV. Let me read a book or do a puzzle and then quickly I am available. I can jump up and come or go for her. I can think.

I had a compulsion to stay busy with paid work. That is the opposite, that means I was not available quickly. But these were little, short-term temp jobs. I asked her just once, “Hey, I’ll come for a visit, we can play Scrabble, I’ll just …”

“No. I told staff at the front, no visitors.” But, I only asked her the once. From there I thought I was being obedient. It was rigid thinking. She had rigid thinking because of the anorexia (or the OCD). I was the dutiful person who would help out by doing what I was told–but what is required is flexible analysis, and revisiting. Ask. Then ask again.

Ask yourself, “What would she do?” Answer to that was, “She would do something cheerful, like bring flowers (even though request was no visitors).” She would not be stuck on texting. She would try Facetime–that would have revealed her secret. Gemma would pay a surprise visit, even just to the staff–to meet them and ask after the patient, “How is she?” She would be kind. She told me the expression, “Given the choice whether to be right or be kind, be kind.” Healthy Gemma would have chosen kind. Happy and kind. Not concerned, disappointed, and doubtful. She would have got it right.

I heard from Erin’s mother today. Erin died an accidental death at home but it may have been ED connected. She had been on the unit in, maybe sometimes at the same time as Gemma. The doctor being scrutinised was the same, or at least the name was familiar, one of multiple medical people involved on the ED ward. Her daughter spoke of Julie, and how “the system” let Julie down (there is no system). Erin’s mother said the psychiatrist released Julie to her own care, to go home. 100% predictable result. For sure the doctor can point to the Mental Health Act, which says a patient has a right to refuse treatment. But I see it as negligent, that the patient who hasn’t the capacity to make a decision, nor the mass to be a viable human, then keep them, persuade them, section them, to stay on the ward–you cannot be “conflict averse” and uphold the oath to “Do no harm.” To release a patient that is a threat to themselves is unconscionable. I don’t think they will get in much trouble over this–doctor, doing the best they know how, under the circumstances, to treat, or release girls, women, one after the other after the other. People indifferent to recovering. Ambivalent about feeling better than indifferent.

I will never know who or how many, over at least five years, have been turned out because “they decided” to go with the anorexia, rather than recovery. While I thought that the definition of anorexia is refusing treatment–it might be the combination of anorexia plus OCD. After researching OCD on the net the other night, I think what drove Gemma’s illness was OCD. She could treat the noisy, bossy, nasty, self reproaching accompaniment going on in her head, by focusing on something. While she focused on food and restricting behaviours, the noise was not so bad. Giving up anorexia meant the OCD was back with a vengeance.

She could quiet the OCD her with restricting and thinking of food 100% of the time. Mental health is complicated. Medical intervention helps. But medical people can be conflict-averse and cave easily to the demands of the mental health monster. Once the supporter sides with the illness, the patient feels they were not worth the trouble. Patients with eating disorders can feel unworthy of treatment thinking, “I’m not sick enough.” Or even, I’m not sick at all.

I was a supporter who believed Gem when she said, “It has to be for myself; I can’t recover if it is a demand from other people.” She said it was the reason other attempts failed. I figure other times did not fail–she gained weight and health and her happy outlook came back. If she got busy she became vulnerable to not maintaining her weight–the OCD came back as her defences got frail, and she lost weight and judgement.

“I’ll recover for myself,” is a fake goal that maintains the illness. “If I do it for myself, it will stick.” You just have to do it and not for anyone, because the illness will find a hole in motivation–“Me? I don’t feel like it just now. I think I’ll take a rest and someday decide to do it myself.” Cod-swaddle. She was tricked by her own sense of purpose.

Anorexia is a monster. OCD is even worse. Patients would like to keep the anorexia, because they feel it defines who they are (whether that feels like strong, restrained, confident; or sick, needing care and attention). On the other hand, the patient would like to get rid of the noisy OCD. One article said, “With a tumour on your brain, would the surgeon decide to remove some of the cancer, and leave some of the cancer?” To rid yourself of OCD, and keep the compulsion to restrict–not going to happen.

You will always have the OCD but you can learn to keep it under control. Mask it with mal-coping behaviours that relieve the OCD, and now you can’t stop the behaviour or the noise–self-chastising talk becomes overwhelming. Overwhelmed people seek help.

What siding with the illness sounds like, “You’ve chosen discharge? You’ve decided it will work for you to isolate and treat yourself?” Death sentence. Eleven specialised years of education and a naive or ill-prepared psychiatrist can be just as dumb as the next person. Disaster.

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