Tag Archives for eating issues

Health at Every Size

My relationship with food and my body has always been a difficult one. I spent my teens binge-eating, and my student years borderline underweight and terrified of gaining. Then I was prescribed an antidepressant that happened to cause rapid weight gain (a rare side effect), and to my utter amazement, I developed boobs. I had been convinced that I would be flat-chested at any weight and therefore needed to stay as skinny as possible, but in fact putting on a stone or so gave me enough cleavage that I was less worried about the size of my waist. For a while, I was relatively relaxed about my weight. More pounds crept on, but my BMI was still in the healthy range and I was now a DD cup. I wasn’t entirely happy about my apple shape, but if I chose my clothes carefully, I thought I looked all right. Eventually, though, I reached the point where I was classed as overweight and it may not be coincidence that around the same time, I started to think I looked fat in any outfit. It was time to lose weight.

My first diet was a success, or so I thought at the time. I got details of the WeightWatchers points system from my partner and once I’d learned which foods would fill me up and which treats I could ‘afford’, I lost the weight fairly painlessly, stopping half a stone or so below the maximum ‘healthy’ weight for my height. I kept the weight off for a good while too, following WeightWatchers’ plan for maintaining weight. But then, a year after I’d started the diet, several traumatic events and life stresses had me turning to junk food for comfort again. Slowly but surely, I started to regain weight until I was back where I’d started.

I tried to diet again, and this is where it all went horribly wrong. I was now a vegetarian, limiting my options, and I was on a higher dose of antidepressants which are known to cause increased appetite. The situation with my mental health had also gone from ‘in remission from depression for several years’ to ‘frequently relapsing’. Whether because of all this, or for some other reason, sticking to a calorie-controlled diet in any kind of sensible way seemed almost impossible. Every time I tried, I either gave up because I was so hungry all the time, or a switch seemed to flick in my head and I would start starving myself. I have spent the past couple of years yo-yoing from overweight to my target weight and back again. I most recently dieted in May-June last year and by December I had gained two stone. I now have a BMI of 27, which is the highest it’s ever been, and I’ve been feeling deeply unhappy about my size.

When fatigue stopped being my biggest problem, I knew I wanted to do something about my weight and body image, but what? I didn’t want to start another diet, get sucked into an eating-disordered mentality and end up larger than ever, so I eschewed the usual weight loss resources and tried to find something aimed at people like me. People who might not have a full-blown ED, but do struggle with eating-disordered behaviours. This led me to a book called Getting Better Bit(e) by Bit(e), which has a chapter specifically for people with a history of binge eating or bulimia who are overweight.

What I read shocked me. I had assumed that, as my BMI is ‘unhealthy’, I needed to lose weight and should just find a more sustainable way of doing so. Instead, the authors – both psychiatrists who specialise in eating disorders – told me that the health risks of being overweight have been greatly exaggerated, especially for people who are in the ‘overweight’ rather than ‘obese’ category. That it’s far more important to be physically fit, and above all that repeatedly losing and gaining weight does a lot more damage than simply being overweight.

Not long after this, purplepersuasion published an excellent blog post about her own cycle of dieting/restricting and bingeing/regaining, and one of the commenters recommended the Health at Every Size concept and Linda Bacon’s book. I bought a copy and devoured it. What Bacon says (I’m loving the potential for food-related puns :P ) makes so much sense to me and has already made a huge difference to the way I feel about my body and food.

In a nutshell, HAES is about being healthy irrespective of how much you weigh or what your BMI is. It’s an approach focused on intuitive eating, physical activity and self-acceptance rather than dieting or weight loss. The book provides a lot of scientific evidence that backs up what I’d learned from Getting Better Bit(e) by Bit(e), and shows that:

  • Diets don’t work in the long term. Over 99% of people who diet regain the weight.
  • People with a BMI over 25 are more likely to develop certain health conditions such as high blood pressure, cardiovascular disease and diabetes, but there’s no proof that being overweight or obese causes these things. It’s more likely that the causes are other factors which often go hand in hand with being overweight, such as a poor diet, not getting enough exercise and a pattern of losing and gaining weight. (The exception is osteoarthritis, which is directly caused by obesity.)
  • There is some evidence that people who are overweight, as opposed to obese, are healthier and live longer than people towards the lower end of a ‘healthy’ weight range.

Why don’t diets work? Bacon argues that everyone’s body has a ‘setpoint’, a weight range of about ten pounds which is natural and appropriate to them and which their body will try to maintain. If you go below your setpoint, your body will do everything in its power (increased appetite, cravings for calorie-rich food, lowered metabolism) to regain the weight. If you go above your setpoint, your body will also try to lose the weight but it’s not as efficient at doing this, because our bodies aren’t really designed for a modern environment where we don’t have to go out and hunt our own woolly mammoths – or whatever it was that cavemen ate. When you diet, your body assumes that food is scarce and it may even increase your setpoint to better protect you against the next ‘famine’. As I understand it, the stuff in this paragraph hasn’t been proven beyond all doubt yet, but there is a lot of evidence to support it.

Instead of dieting, Bacon recommends:

  • Eating as much as you need to satisfy your hunger, stopping when you’re full.
  • Choosing ‘real’ foods over processed foods where possible, and eating a wide variety of different foods (this is a good way to make sure your diet is nutritious without becoming a slave to nutritional facts and figures).
  • Allowing yourself the foods you crave, but eating them mindfully and stopping when your body’s had enough.
  • Regular (but not excessive) physical exercise.

(There’s a lot more detail on how exactly to do all this in the book.)

I’ve been following the HAES approach for a couple of weeks now and I think it’s brilliant. I haven’t totally got the hang of mindful and intuitive eating yet, but what’s incredible is that all my urges to binge and overeat have vanished. I really didn’t expect that to happen. I didn’t think I was prey to the “I’ve blown my diet anyway, I might as well stuff my face” type of thinking – I’ve done CBT, I know that’s neither rational nor helpful – but I hadn’t realised just how much the shame I felt about my weight and my eating was triggering me to turn to food. The idea that there’s nothing wrong with being fat (Bacon deliberately uses the term ‘fat’) and that I can be healthy at this size is very liberating. HAES is supposed to help your body return to its setpoint and I have to admit I am hoping my setpoint will turn out to be lower than my current weight – I’m also encouraged that I’ve had to tighten my belt by one hole since I started HAES. :D But the focus on self-acceptance and on health is more important and is what’s really helping me.

Looking towards 2012

I haven’t felt like blogging much lately. Or rather, I haven’t felt the need to blog. What started out as me not writing often due to fatigue seems to have blossomed into another phase of my life where I feel able to just get on with things and take care of myself without needing to talk about my mental health so much.

I spent the first week in December filling out an activity and fatigue diary, as recommended by my book on pacing and grading. It’s basically a record of every activity you do (including resting) and for how long, together with fatigue scores from 0 to 10. At the end of the week, you highlight low fatigue scores in yellow, high scores in blue, low/medium/high-energy activities in green/orange/red, and pleasurable ones in pink. This is supposed to help you spot certain patterns that can worsen fatigue or keep it going: for example, taking on too much when you feel all right then crashing (‘boom and bust’), or using up all your energy on things you ‘should’ do and not taking any time for activities you enjoy – which can actually improve energy levels, particularly if your fatigue is linked to a mental health problem.

To my surprise, my diary didn’t show either of those patterns. What it did show was:

  • All my pleasurable activities were also high-energy ones (this caused some conflicts with the highlighting pen). Granted, it’s a busy time of year for choir, but it shouldn’t be my only way of enjoying myself.
  • Checking Twitter, Facebook and my RSS reader on my phone drained an awful lot of time and (presumably) energy.
  • The week I chose to fill out the diary turned out to be an exceptionally bad one for fatigue.

They may seem like small things, and at first I felt disheartened that I didn’t have much to work with, but I think they’re important. You can probably guess my response to the first two items. I’ve started rereading the Harry Potter books for fun relaxation :D and I’m spending less time cycling from app to app on my phone. I’m actually planning a bit of a cull for the New Year where I will try to keep only people I connect with in a meaningful way and non-personal blogs/accounts I find genuinely helpful. Of course, that’s only half the battle and won’t stop me from constantly checking Twitter et al or adding 10,000 new people to follow, but I’m hoping I can stay out of the habit and find more meaningful ways to spend my time.

As for having a particularly bad week, I don’t think this was coincidence. There’s nothing like constantly focusing on your symptoms to make you feel rubbish, or keeping an exact record of your activities (if you’re me) to make you feel you’re not using your time productively enough. What’s really surprised me, though, is that when I stopped keeping the diary I didn’t just return to pre-diary levels of fatigue – my fatigue went away almost completely. Until I came down with a cold after Christmas, I’ve been absolutely fine for weeks, and I don’t feel excessively tired now for someone who is slightly ill. Of course, there are many possible reasons for this – it could be a result of the little changes I’ve made, or my brain chemistry finally getting back to ‘normal’ after the let’s-reduce-the-mirtazapine experiment, but it’s reminded me once again that there is a balance. Ignoring my symptoms and feelings and ploughing on regardless is bad, but so is focusing on my symptoms too much, especially if that means living in the moment to the extent of never taking a step back and engaging my ‘rational’ mind. Sometimes, the things you need to do for recovery are counter-intuitive, like steering into the skid on an icy road, and you’re not going to find them by listening only to what your body and mind tell you you need.

Over the past couple of weeks, an idea has been forming in my head. I’d like to make a New Year’s resolution for 2012. It’s been a while since I did this, but what I like to do and what has worked well in the past is to have a central focus that I can keep returning to, no matter how many times I wobble off course, throughout the year. For example, eight years ago, when I was severely depressed and finding it almost impossible to function in the ‘real’ world, I decided the time had come to make my mental health top priority and that was what guided my often difficult decisions in 2004.

So for 2012, my resolution will be:

FOCUS ON SELF-CARE

For too long I’ve been using my mental health problems and my career as twin excuses to neglect my own self-care. I may have good reasons (depression/childhood trauma) for self-destructing, and I may have good reasons (financial ones) for taking on too much work, but I can’t keep cycling between the two like this. It’s exhausting and only makes things worse in the long run. I need to focus on what works, not on what keeps me stuck or makes me relapse.

I have some more specific goals within that overall aim. I’d like to get more exercise, and in particular find nice places to go for daily walks. I’d like to eat more healthily and get back into the habit of a weekly supermarket shop and planning meals. I’d like to decide what to do about therapy (actually, I wouldn’t because thinking about it bloody terrifies me. Let’s rephrase that: I need to decide what to do about therapy). But the important thing is that I keep coming back to my focus. I am not always good at balance, and this is something that can help centre me.

Chronic fatigue

Following my GP’s comment about chronic fatigue syndrome a few weeks ago, I logged onto Amazon and bought a few books on the subject. I’m not at all certain that I have CFS (or ME as it’s also known), and my GP thinks depression is the correct diagnosis. However, I’ve now had a couple of episodes of ‘depression’ where fatigue was a more prominent symptom than low mood, so I wanted to find out more – both to see whether the CFS label might fit and to learn some pacing techniques.

I’ve just finished the first book which is Beating Chronic Fatigue by Kristina Downing-Orr. I’ve written a general review of the book on Goodreads, including my reservations about the treatment plan the author offers, but here I’d like to relate the book more to my personal experience.

Of particular interest to me was the chapter on the differences between depression and CFS. According to the author, many people with chronic fatigue are misdiagnosed with depression. Here are some of the differences she highlights:

With depression, people often feel apathetic and lose all interest in or gain little pleasure from activities they previously enjoyed (anhedonia). Most CFS people can’t wait to recover, so they can again actively participate in their life’s previous joys. As a result, they often feel frustrated by and impatient with their lack of recovery.

I have certainly experienced apathy and anhedonia when depressed, but with my most recent episode, and the one in 2009, I don’t remember this being the case. I still enjoyed the things I normally would, when I had the energy for them. I wanted to be able to get on with my life and felt frustrated that I couldn’t – though it’s hard to be certain whether this is because I was enthusiastic but exhausted, or whether I just wanted to become more ‘acceptable’ and feel like less of a failure.

Depressed people often don’t want to get out of bed in the morning because they believe the day will lead to nothing other than hopelessness and despair. In contrast, people with CFS can’t get out of bed because they simply don’t have the energy or strength to do so.

Again, I’m no stranger to loss of motivation, hopelessness and despair, but this year and in 2009 my experience was overwhelmingly one of lack of energy and strength. I feel more sure about this than the previous point. I really wanted to get things done but I just didn’t have the energy.

When people with CFS go out or exert themselves a little too much, they can feel both mentally and physically worse, often leading to a lengthy setback. However, when individuals with depression push themselves and go, say, to a party, they often feel better for having made the effort. Mental exertion in CFS can lead to a worsening of physical and psychological symptoms. In depression, there is no detrimental effect.

My experience is absolutely that I can push myself too hard and there is a detrimental effect (in the case of the party, I might well enjoy it but still pay the price with exhaustion the next day). However, I know a lot of people with depression who’d say the same; surely they can’t all have CFS. Some mental health experts, such as Tim Cantopher, have said very similar things about depression i.e. that pushing yourself too hard can lead to a setback and delay recovery. For me, whether my main symptom is low mood or fatigue, it’s crucial to find a balance between doing too much and too little.

Other hallmarks of CFS that the book points to are flu-like symptoms and post-exertional malaise (feeling worse after exercise). I definitely tend to feel worse after a busy day but I’m not certain whether exercise itself is the trigger. As for flu-like symptoms, the only one I have is aching muscles which isn’t enough for a diagnosis using the criteria the book provides. Incidentally, other descriptions of CFS I’ve read online seem to fit me better.

My verdict? I’m not about to diagnose myself with chronic fatigue syndrome or go out and buy the 16 nutritional supplements the book recommends. However, it’s clear that fatigue is a real problem for me and that I no longer quite fit the ‘standard’ picture of depression. I will continue to look for information on pacing (this book was a bit vague on it) and I’ve also decided to make diet a priority, as I’ve been relying on processed convenience foods when exhausted. There are so many areas of my life I’d like to sort out and don’t have the energy to, but I’m hopeful that eating more fruit, vegetables and lean proteins will actually give me some of that energy. My aim is not to restrict the amount I eat or ban certain foods, but just stock up on all my favourite healthier ingredients (and not keep a lot of junk food in the house) so it’s easier for me to eat better. Unfortunately, this will require a trip to Evil Tesco. I’ll keep you posted…

Sparkly turquoise magic diagnosis

I’ve always had a bit of a love-hate relationship with diagnostic labels. I love being able to give a name to my difficulties and pin them down in a way that will hopefully lead to treatment and recovery, but I hate it when the label inevitably isn’t a perfect match. My main official diagnosis is recurrent depressive disorder, but although I clearly do get recurrent episodes of depression, the label doesn’t seem to account for all the symptoms and issues I have. As a former psychology student, I’m well aware that diagnoses in mental health are really just convenient categories for clinicians and researchers – and that the criteria for diagnosing a particular condition will change depending on where you are in history or which system you use.

That’s why I’m indebted to purplepersuasion for drawing my attention to Dr Jim Phelps’ “paint pigment” model of diagnosis. Phelps says:

Imagine that people are like cans of paint.  Everybody starts out basically neutral, then genes and experiences add colors to their can.  If you end up with too much of one color, you’ll “stick out” compared to everybody else.  We might call your difference a “symptom”, if it causes you to have trouble with functioning in society.

Now let’s take the “paint” approach to “borderline vs. bipolar”, a common diagnostic disagreement.  You may have already seen my essay on this, which notes the almost complete overlap of symptoms between the two diagnoses.  With that much overlap,  these people must have basically the same “pigments”.  One person might have gotten them from genes, the other from experience — we can’t tell the difference yet.

However, one pigment seems to differ in each.

They both have red for hot emotions, and blue for depressive symptoms, and a sparkly pigment that makes them impulsive.  But the “bipolar” person has a magic ingredient that makes her pigments vary cyclically over time. On the other hand, the “borderline” person has a green ingredient that makes her feel empty, and feel much worse in this way when she is alone.  If you get a lot of this green pigment, you’re more likely to have trouble in relationships.

If I use Phelps’ pigments, and assume that other relationship/personality-type issues might also be some sort of green, then I end up with a sparkly turquoise magic :) diagnosis:

  • Sparkly stands for trichotillomania, disordered eating and other impulsive behaviours. Incidentally, some antidepressants make me more sparkly (but not ‘red’, so I’ve never been diagnosed with bipolar).
  • Turquoise is a combination of depression (blue) and perfectionism/relationship issues (green).
  • Magic means that my blue and, to some extent, sparkly symptoms vary cyclically over time.

I’ve found that the best treatment for sparkly turquoise magic disorder is a combination of atypical antidepressants and psychotherapy.

What’s your diagnosis? Feel free to invent your own colour or pigment for symptoms not covered above…

Group therapy week 5

I’ve been finding it hard to participate in group therapy for the past four weeks, and yesterday’s session started out no different. A member of the group was talking about body dysmorphia, saying she felt she was the only person in the group with these kinds of issues, but I didn’t feel comfortable sharing my own struggles with crap body image and food. It’s hard enough baring your soul to a therapist, and a group of seven people is incredibly intimidating. I felt like such a failure that I couldn’t reach out. The conversation then turned to the summer break, which worried me because if I don’t feel I’m getting anything out of the group, it’s going to be very hard to go back after a gap of several weeks.

But then another patient abruptly started talking about his relationship issues (by abruptly, I mean there was no apparent link with the previous conversation). To my amazement, he began to describe everything I’ve ever been through. There were differences, obviously, and he’s single whereas I’m married, but the underlying feelings were almost exactly the same. When he said he felt like a freak and didn’t think anyone else could relate, I couldn’t stay silent. I explained the problems I’ve had and still have, and we talked about me for a while.

After this, Group Therapist cunningly brought the conversation back to the person with body dysmorphia. He said he was pretty certain there were other members of the group with similar issues. I don’t know whether I was the only one who’d been keeping quiet, but I grinned and ‘fessed up. I talked about my body image problems and said that although I didn’t seek help and thus was never diagnosed, I think I had bulimia as a teenager, and that I still go through phases of disordered eating.

I feel so relieved that I’ve started to contribute, and that I’m connecting with other members of the group. A small part of me is still questioning whether group therapy is going to be enough – I ‘could’ have talked about my stuff for a whole hour in individual therapy. But I’ve put that word in inverted commas because these are not issues I’ve really addressed in therapy before. The eating stuff has been mentioned briefly in assessments and I wrote about it in more detail on the referral questionnaire, but yesterday was the first time I’ve used the B word. And those particular relationship issues have only ever been alluded to in the vaguest and briefest of terms. They are things I am deeply ashamed of, things I know I need to work on but didn’t think I could ever bring up, and I was able to yesterday because other members of the group showed me I was not alone with them. Being in a group has its advantages!

Liebster Blog awards


Liebster Blog award

I’m really pleased to have been given a Liebster Blog award by the lovely Narky. I haven’t been blogging publicly for long and it’s my first award, so it’s an honour – thank you! :)

In turn, I get to pass the love on to five blogs I really like. Traditionally, the Liebster Blog award is for smaller or lesser-known blogs, so I’ve taken this into account when making my choice, as well as picking blogs which (to the best of my knowledge) haven’t been given it before.

So, without further ado, here are five blogs I think are gems:

  1. Dedication to recovery writes about her own experiences of bipolar disorder and BPD with lots of tips on coping with mental health problems – things she wished she’d known when she was first diagnosed.
  2. Giant Fossilized Armadillo blogs about life after recovery from an eating disorder. She’s also a talented photographer.
  3. Ponderings from me is a fellow self-employed mentalist with a love of church music.
  4. This Compassionate Life shares her experiences of severe depression, anxiety, BPD and Buddhism in a way that always has me reflecting on my own.
  5. Bethlehem Blogger works for a Palestinian charity in the West Bank, and has taught me a lot in the short time I’ve been reading her blog.

Congratulations!

I feel…

I feel lost and unsure, paralysed with indecision. I don’t know what the way forwards is from here. I have started to work half days and am pleased about managing this but it makes it harder to take care of myself. Work has a habit of taking over.

I feel fat, bloated and unattractive. I have gained the best part of a stone. I want to restrict but I suspect this would fuck everything else up.

I feel tired, but with the potential undercurrent of energy that would come from restricting. I’m so sick of being tired.

I feel I want to take a bath, but I showered only a few hours ago so I tell myself I can’t. It would be a waste of water.

I feel frustrated that I’ve completed my half day’s work and should be doing something nice for myself but I can’t because I’m frightened of making the wrong choice. I feel worried that most of the others in my therapy group have been there for years and years and that this may be a sign it doesn’t really help people.

I’m scared of getting it wrong. I’ve just realised this, writing this post. It makes me feel better to be able to pinpoint it. :)

I’m embarking on scary territory here. I’m starting an unknown kind of treatment (I have never been in this type of therapy group before) and I’m trying out a new way of being. Of course there are risks, there are things that may not work. So I feel paralysed because if something doesn’t work I will have made The Wrong Choice and it will be All My Fault. Except that in an experiment, the whole point is to try things and observe what happens. This is kind of an experiment. I can’t ‘get it wrong’ as long as I’m observant and learn from things.

I will start small. It’s 3:45 pm and I’ve finished work for the day. I feel like popping over to Tesco to buy some bleach because (a) the bathroom is disgusting and we have no bleach and (b) I’d quite like some exercise and (c) I haven’t been out of the house yet today and (d) I need to get some change for the bus to my psychiatrist appointment tomorrow. But then I worry that this is too rational to really be ‘what I feel like’. Never mind – I will try it and see how it makes me feel. Maybe later I can take a bath in my nice clean bathroom.

Self-help or self-harm? On recovery, part III

I’m a wordsmith, so when I founded Sirius Project back in 2003, I chose the name carefully. Sirius is both an acronym – standing for Self-Injury Resources, Information, Understanding and Support – and the brightest star in the night sky. I had only just set out on my own journey of overcoming self-harm, but my aim was to create a supportive (online) place for people who self-injured, a collection of resources and information that might be useful to them, and a source of hope for recovery.

Over time, Sirius evolved to fill its present tagline, “self-help for self-harm”. For those who aren’t familiar with the site, I use the term self-help in a very broad sense, to cover any steps people can take to help themselves, including proactively seeking treatment. Likewise, the focus on self-help is not meant to imply that people who self-injure do not need professional help, more to cater to those who are having difficulty accessing such help. In practice, the site focuses on two main areas: yes, there are self-help ideas for self-harm and related mental health problems, but there is also information about getting the best from the NHS and details of alternative sources of help (e.g. charities and the private sector). “Self-help” is probably not the best term to cover all of this, but the wordsmith in me loved its linguistic parity with “self-harm”.

Today, I’ve taken that tagline and turned it on its head. “Self-help or self-harm?” I’m not talking about Sirius specifically, but about self-help techniques in general. Are they actually helpful, or can they be harmful?

That might sound like an odd topic coming from me. I am strongly self-help-oriented. In the years that I was cutting myself, I got very little meaningful help from the NHS, and I essentially recovered – from self-harm, not the underlying problems – without professional help. Instead, I relied on the support and ideas of others who had stopped or were trying to stop harming, and I shared the things that worked for me in turn. With my other mental health issues (including depression, trichotillomania and social anxiety disorder) it’s less clear cut, and I’ve benefited from professional help for all of those things, but self-help – including bibliotherapy and CBT and DBT techniques – has also played a role.

For me, a major advantage of self-help has been it’s something I can turn to even when I’m stuck on a waiting list or being denied NHS help, and if you go back to my broader definition, I think some degree of what you might call a “self-help attitude” is necessary for recovery, especially for conditions that cannot be treated by meds alone. It’s not enough to simply turn up to therapy sessions: at some point you have to become willing to engage with treatment, to talk about the difficult stuff, to make changes in your life, even if there’s not a thought record or DBT handout in sight. ;)

Where, then, does the harm come in?

I posted earlier today about my experiences of NHS CBT which was little more than guided self-help and how, while it helped me manage my symptoms, it didn’t lead to recovery from either depression or social anxiety. It’s been really interesting to learn from Giant Fossilized Armadillo that CBT doesn’t have to be like this. Although people with mild problems may only need short-term skills training, “full” CBT is supposed to tackle the root causes of psychological problems and can be longer-term for someone with severe and complex difficulties. My understanding is that CBT is still meant to work a lot quicker than, say, psychoanalysis, but it should last for as long as the patient needs it to, not for a fixed number of sessions after which you’re discharged and told to carry on by yourself.

In fact, I’ve been having quite an interesting dialogue with GFA over the past couple of days. Her story is somewhat similar to mine in that she recovered from anorexia largely on her own, after eating disorder services wouldn’t offer her further therapy because she had relapsed too many times. In a recent blog post, she says:

“I randomly came across a blog a few days ago where someone stated that they find stories of how people recovered without specialist help really triggering, because it makes them feel bad for needing help. That made me feel guilty, because of course I have a massive section of my blog dedicated to solo recovery, and upsetting other people was the exact opposite of my intentions.”

She then goes on to acknowledge that it’s difficult to pin down the factors that would enable someone to recover without specialist input, but that she doesn’t think it’s a matter of determination or willpower:

“I stand by my belief that it has nothing to do with personal strength, motivation, determination or willpower, because that makes it sound like all anyone has to do is make the decision to get better and stick to it – and if that were true, I would have recovered at 15, not nine years later. If that were true, no one would stay ill for long. It felt more like a thousand circumstances and thoughts and feelings all came together at just the right moment in my life to somehow make it possible for me to break out of the downward spiral I was in.”

Finally, my introductory sessions with my (psychoanalytic) group therapist-to-be have also got me thinking about my self-help efforts in a different light. I’m coming to realise just how difficult it is for me to turn to others for help and support, and to see this as a key factor in my need for less-than-healthy coping mechanisms and in my relapses. Although this pattern has its roots in my childhood, surely the NHS’ expectation that I “become my own therapist” after just a few sessions of CBT hasn’t helped. As for the techniques themselves, at their best they have kept me alive and allowed me to build a life worth living, but at their worst, they’ve fed into my perfectionist tendencies and been another stick to beat myself, another way of pushing myself too hard.

My current concerns about self-help, then, are basically that it has its place and its uses but that it can also easily be abused. People with severe or complex mental health problems may benefit from learning some self-help techniques, but surely this needs to be part of a much larger picture where all their issues are addressed and where support is available for as long as it’s needed. Care needs to be taken that any techniques taught are appropriate for that particular patient and not going to exacerbate perfectionism, feelings of inadequacy or any other issue. I will not stop using my self-help techniques but I will do so with a far greater awareness of how they can impact the whole picture of my mental health.

As for Sirius Project, my wish for the site to evolve is not just about dwindling numbers of forum members and the need for more volunteers. I have some concerns about the message I may unintentionally be putting across. I worry that readers may take “self-help for self-harm” to mean that people who self-injure don’t really need proper professional help, and not visit the FAQ page for a fuller explanation. I worry that by providing details of CBT and DBT skills, I may be perpetuating the myth that the behavioural therapies are just a form of self-help, and again that people with complex issues don’t need longer-term involvement. I worry that people may feel overcoming self-harm is just a matter of willpower and determination and berate themselves for not being strong enough. In practice, sadly, there are always going to be people out there who can’t access appropriate professional help, whether that’s due to NHS failings in the UK or lack of health insurance in another country, and I want to offer whatever I can to help them. There is hope they may recover (from self-harm at least), because I did. Yet I feel that by sharing information and ideas and my own “inspiring story”, I’m treading a fine line. The last thing I want is for anyone to take Sirius and use it as a rationalisation for not offering proper treatment to those who self-injure.