The Filing Cabinet in my Head
Like so many people I know, I suffer from multiple illnesses and each one is considered “invisible” as in, I struggle all day everyday but all of my symptoms are inside. The main diagnoses are Depression, Anxiety, Fibromyalgia, Endocrine Disorder, and an Eating Disorder. Like so many people I know, I mostly suffer in silence.
I am going to be talking about specific symptoms and foods. If this is something triggering for you, I trust that you will do the self-care you need to do.
There is so much stigma, silence, and misinformation about mental illness, especially Eating Disorders, which leads to misunderstanding and ineffective treatment.
I experience weight stigma at every doctor’s appointment where regardless of the symptoms I am there for, the medical advice always includes weight-loss. Most recently, I had a neurologist tell me that I need a breast reduction.
There are so many reasons that this weight-related advice was dangerous. First, telling someone with an active Eating Disorder that they need to lose weight is giving your patient permission to kill them self through ritualized malnutrition. Second, it completely invalidates their experience. 30 years of restricting and purging and disordered eating, along with an endocrine disorder, has completely messed up my digestive system and my metabolism. I will never be thin. Genetically, and due to my illnesses, I can be thinNER, but the unreachable goal of thin is a slippery slope to engaging in ED symptoms. Third, it perpetuates the misguided notion that thinness is the determinant of health and completely disregards all the other factors in a person’s life.
When I say I have voices in my head, I don’t mean that there are different people with different voices and different personalities. What I mean is that my brain collects every negative comment ever made and then categorizes them into body and non-body related comments. My brain also twists the words of kind-hearted people who make innocent statements and stores them in my hippocampus. My medial temporal lobe stores those morphed memories as further ammunition against myself; further evidence of my fatness and my inability to be in control.
Holding onto negative comments and bad experiences is actually built into our brain as negative evolutionary bias. We have to remember negative things or we will suffer needless harm. For example, if you are crossing the road and a large truck comes speeding by, you need your brain to automatically remember that being run over by a truck would be bad. Very bad. Being aware of our surroundings and having “files” in our brains that keep us alive is a good thing. Unfortunately it can affect more than remembering that poison ivy is bad, and tickling a grizzly bear would also be bad. We tend to allow negative experiences and comments to stick to us like Velcro.
The voices are simply parts of my brain sending out chemicals accompanied with negative memories and negative thoughts.
For example, when the aforementioned neurologist told me I needed a breast reduction, my frontal lobe decided to send the information immediately to my amygdala which told my body that I was in danger. I was in that exam room to determine if I had a neurological issue. Her misguided advice activated both my sympathetic nervous system (fight, flight, or freeze response) and my cerebral cortex. This means that my body began to produce cortisol and adrenaline while my brain flipped through its metaphorical filing cabinet, reciting all my memories associated with body image and weight. I began to feel the familiar waves of nausea that I get in these situations.
That seems like a normal response that anyone might have in a situation like that. The problem with the psychiatric illness ED, is that this same autonomic response occurs in day to day interactions with others, and even with myself.
Perhaps I catch a glimpse of myself in the mirror, or I have some chocolate milk, or heaven forbid I eat a potato. The shame and judgement that rain down on me is indescribable.
In a social setting such as a restaurant, if someone says “oh my goodness! I’ll never be able to eat all that!”, my inner filing cabinet goes crazy. It immediately becomes about me. If they can’t eat their whole meal, then neither can I. The voice in my head reminds me of every time someone has commented on my body or offered unsolicited advice on eating and weight loss. The voice says, “SEE? They were right. You eat too much and you’re fat.” Instead of my prefrontal cortex analyzing the information and throwing it away, that moment is stored in my long term memory and pops up whenever I eat with that person, or whenever I think about that person, and sometimes just randomly.
I’ll be driving to work and suddenly I’ll remember someone saying “I’ve seen what you eat at potlucks.” Or I’ll remember being called “whale woman” when I was 13.
In the restaurant scenario, the voices begin to remind me of all the other similar situations and thoughts and no matter how hungry I am, I will stop eating when the people around me stop. Sometimes, my amygdala goes into red alert and all the memories are mixed together like the blades on a spinning fidget spinner. I begin to look at my plate of food and just push the food around without eating it. If I can’t activate my parasympathetic nervous system (rest and digest), I begin to panic about how fat I am and what I ate that day.
The tension builds in my body. My muscles tighten, my heart beats faster, I get hot and my skin turns red. I begin to feel waves of nausea. The voice begins to pull out files from my brain and recites all of the memories of me being bullied in Middle School, of the recent bullying I experienced from my boss, and the anxiety response kicks in: what if I have to work with that boss again? What if I run into her on the street? What if she is in THIS restaurant right now?! What if she sees me?” My amygdala has told my body to prepare for fight or flight. My blood has rushed to my arms and legs and has given me the adrenaline I need to survive this imaginary attack. My stomach heaves from worry and I excuse myself to go the bathroom. I stand in the stall and take deep breaths through my mouth. My brain tells me over and over again that I KNOW if I vomit I will feel better. All the gnawing and waves of nausea and panicked thoughts will slow down. My heart rate will stabilize. The memories will go back in the filing cabinet and I will feel better.
I have suffered from the symptom of purging for so long that it has become my coping mechanism. It isn’t about food. It’s about the emptiness of my belly feeling like calm and peace. It’s about getting the thoughts – the voices – to stop. It’s about feeling out of control and knowing that this is one thing I have absolute control over; what goes into and out of my body.
Last week someone said to me “if your thought is to do something harmful, that’s your Eating Disorder talking.” So standing taking those deep breaths to reduce the level of cortisol and allowing myself to access my prefrontal cortex means that I can see my options and make a decision instead of following the impulse.
Eating Disorders are not phases. They are serious psychiatric illnesses with deadly consequences. EDs have the highest mortality rate of any mental illness. And yet the health system (and the internet trolls) focus their attention on the “obesity crisis”.
If children were explicitly taught skills for when they feel disregulated, and explicitly taught how to nourish their bodies, minds, and spirits, perhaps treatment of the illness would be more accessible and more effective. Unfortunately, weight stigma is so pervasive that it unconsciously invades all facets of life.
Meanwhile, back in the bathroom at the restaurant, my desire to recover to a healthful state is just as strong as my desire to end this mental, emotional, and physical suffering by throwing up.
And so the battle begins.
There are times when it happens so quickly that I don’t have time to fight it. The nausea hits hard and fast and I can’t stop myself. But other times, I am able to use the skills that I have learned to activate my parasympathetic nervous system. This means that my heart rate and my breathing will slow down. My blood pressure will get lower and my skin will get cooler. When this happens, it’s like turning off a red alert.
You know that feeling when you are coming off a rush of adrenaline? That is what I am trying to do when I use my skills. I’m trying to turn down my stress response.
If I don’t turn down that stress response in an intentional and healthy way, throwing up will do it quickly. It’s almost immediate. There is a rush of calm and quiet. But then the shame and the judgement set in.
For the last few years, I’ve been getting better and better at using healthy coping skills instead of maladaptive behaviours. The majority of the time I am able to hush the voices enough, to slow down the over-flowing filing cabinet from spitting out all the files, and to calm myself down. This has increased my nutritional intake, and my organ function. It appears that I am no longer dying a slow and silent death.
I am choosing to live.
My goal is to not only continue using healthy emotional regulation skills, but also to refile my memories into categories about other people. The woman who said “I hope you’re only ordering salad”, the stranger who called me a fat bitch, the woman who told me not to worry because she wouldn’t be putting out any snacks …. those are their issues. Not mine. I do not and cannot own other people’s stuff. It isn’t mine. And I’m tired of carrying it around inside of me. Those voices aren’t mine.
If you or someone you know are struggling with an Eating Disorder, please consider contacting the following: