A Letter of Hope and Thanks

Sometimes clients want, and need, to find a way of sharing their recovery journey. Thanks “Sami” for your story and desire to reach out to others, who no doubt, will be able to resonate with so much of what you have said.

Dear Roger,

I agreed to see you because I thought I had to see you. I had to do it to please other people around me and shut them up so they would get off my case. Did I think that I had a problem? Not at all.

I reluctantly attended the meeting with you and on the way to see you I kept telling myself “This is ridiculous. This is a waste of time and money, and this will not change anything. There is nothing wrong with me and everyone is exaggerating”. I disliked you already before even meeting you. Sitting there in your office looking at you asking me questions my mind was completely blank. I was hearing you but I was not listening to you. I was getting more and more annoyed with you for using the words “anorexia” and “diagnosis”. I was thinking “What rubbish. He has no idea what he is talking about”. You were talking and all I was thinking was how can someone with my weight can be anorexic!?! I am not 40 kg or 35 kg. I am 58 kg so how on earth I can have anorexia? Then I decided to ask that very question and I hated your answer. You said “It’s got nothing to do you with your current weight.

You have already lost more than 57 kilos and that’s almost half of your body weight and you tick all the other boxes for anorexia so it doesn’t matter what your current weight is; that is not determinative”. My thinking was, “Whatever. You can say whatever you want to say. You will not change anything and I will stop when I am 50 kg. Neither you nor anyone else can change the way I think. Anorexia or no anorexia. I am happy where I am. My BMI is still normal it’s not super low so you are wrong”.

I left the first session disliking you even more because now we had a professional diagnosis and I was going to be under more pressure to listen to you and get better from my boyfriend and others who were concerned about me. Did I want to come back and see you? Not at all but I didn’t have any choice really. So I decided to come up with a plan. Initially I decided to negotiate with you and convince you that you were wrong and I did not have anorexia. I was going to convince you that I had been over-weight all my life and now I was finally thin. I was only trying to keep my food intake under control and eating 400 to 500 calories a day or less would not cause me any harm. I tried to negotiate with you that I would stop when I got to 50kg. After all I was a lawyer and quite a successful negotiator most of the time. I can still remember the second session. You listened to me for half an hour without saying a word and I was getting more and more excited because I was thinking “Aha! This is working and he has nothing to say because he agrees with me”. But then to my absolute disbelief you said “Sami I am not going to negotiate with anorexia”. I was shattered so I said “This is not anorexia. This is me”. And you again said “Sami I am not going to negotiate with anorexia.

We are going around in a circle. Let’s get started”. Oh boy! At that point I really wanted to leave and never come back and I really hated you and your black and white approach towards what I had thought was my skill in negotiation. Session after session, I tired the same thing with you and I heard the same response; “Sami I am not going to negotiate with anorexia”. And not once did your facial expression change. You were calm, very attentive and had a kind smile on your face, but in my sick mind at the time you were an absolute devil who was trying to hurt me week after week. Every time you weighed me and I had lost weight I felt like a winner and was laughing inside calling you and other people “losers”. Every time I had put on 200 grams, or my weight was the same as before, I hated you more.

After four or five sessions I did realise that I could not negotiate with you. I still had to come back because I was not given any other option by my boyfriend. So the second phase for me was to think about how to lie to you. I was on a food plan but of course I was not sticking to it. So I had to somehow prove that I was following it and putting on weight. So I started wearing heavy clothes when I was coming to see you and refused to take off mu jacket on the basis that I was not wearing anything beneath it. I used to say that I had been to the bathroom when I had not. I used to drink a lot before seeing you as I knew fluid would increase my weight. My goal was to have a few hundred more grams on me so you would believe that I was sticking to my food plan.

Did it work? Not at all. Even with 400 grams more you used to say “This is not enough. I don’t believe that you have been eating enough. Next time make sure that you are wearing something beneath your jacket so you can take it off and next time please use the bathroom right before the weighing”. I was thinking; “Gosh there is no winning with this guy. He will not give up until he destroys the one thing that I love and that is being in control of my food intake so I can lose more and more weight”. In the first few months you were my number one enemy and I hated you. Nothing was working. Negotiating with you failed. Lying to you failed. Crying failed. Attempting to convince you failed.

I hated that workbook that you gave me. I had to spend hours on it every week and I felt like a little child again who had to do homework every week. I had seen you over ten or 15 sessions and I was still refusing to accept that I had a problem. You asked my boyfriend to supervise my eating and I was hating that because I had to eat. I was crying all the time, I was angry all the time and in my mind I was losing control over everything. I was not doing the workbook and I had all sorts of excuses for that. I can still remember the day you told me “Sami we are not making a lot of progress. Do you want to go into a residential course? If you carry on like this you will have to be admitted to the hospital. You are leaving me with no options Sami…” You said “You look very gaunt and you are in the red zone Sami. Yes your weight might not be low enough in your anorexic mind but you are in the red zone and as your doctor I cannot carry on knowing that you are not willing to change. I have a duty of care and I cannot keep charging for session after session when you are refusing to get better. I want you to get better. I truly want that for you. If you think you can control anorexia and live with it you are in denial – you will eventually lose the battle. Think about the past few months; What have you done apart from thinking about food? What progress have you made in life? If you keep losing weight I will be left with no option but to have you admitted so think about it very carefully”.

I was terrified and on the way back home the penny finally dropped. You were right. For so long I had been thinking about nothing but food and how to eat less and less. You were right; I was not making progress at work. I was unable to study properly and I was constantly fighting with my boyfriend over food and how cruel he was for listening to you and making me eat. I started crying in the car so loudly that I had to pull over. What was happening to me? I suddenly realised that I was really sick. It was the strangest moment of my life because whilst I was very upset I was still trying to negotiate with myself, saying to myself “You can live with anorexia Sami. If you give up on anorexia you will put on weight”. I was shaking, I didn’t know what was happening, I wanted to get better but I didn’t want to put on weight so I said to myself that I would discuss this with you. And I did that at the next session, I said “I do want to get better but I don’t want to put on weight”. You immediately said “That is not possible Sami; without eating more food there will be no cure. You have to put on weight in order to overcome anorexia”.

I left you that day terrified, disappointed that once again I had failed in my negotiation. Then, month after month I went through ups and downs, sitting in your office crying over putting on 400 grams or 300 grams and you patiently trying to tell me that in your medical view that was not a weight gain at all. For nearly two years you had to explain the following, in pretty much every session; “Sami the sooner you start eating regularly the sooner you will get to your set weight point. Believe me, nothing as much as regular eating will help you achieve a stable weight. Trust me. You are beautiful, you are very intelligent, and you have so much to lose if you don’t overcome anorexia”.

After I came back from a long trip I had a bad relapse and I could not take it anymore and so I decided not to see you anymore. But did you give up on me? Not at all. You emailed me again and again to remind me how important it was to carry on and not give up. You said “We can talk about it in person”. You said that I was choosing anorexia and the more I stayed with anorexia the stronger anorexia would get. So I started seeing you again after a few weeks.

Something was different this time, I was so depressed, so starved, so tired and completely exhausted and I just wanted to get out of that state, and so I finally gave in to you. I decided to trust you and your medical opinion and started eating more regularly. I was still very careful but was now following the food plan. It was hard, I was in excruciating pain but I kept going.

I can never forget the day you weighed me after my one week of regular eating. I had put on three kg in one week. I was devastated. My heart was about to stop beating. My whole body went numb. I was crying uncontrollably and I collapsed on the sofa in your office. I will never ever forget that moment in my life. You were sitting on your chair and looking at me letting me cry without interrupting me and I was very grateful for that because I really didn’t want to hear anything. I just wanted to sob, I was mourning for my loss, and yes I knew at that point that I was losing anorexia. I cried and cried and you kept looking at me in silence. I looked at you a few times and all I saw you had in your face was care and a calm smile. Then you asked me what could you do to calm me down? I said I didn’t know. You suggested meditation and I said Okay because I was exhausted and I just needed peace and calm even if only for a few minutes. So we did mediate and for those four to five minutes that I closed my eyes and was listening to you and crying but I felt calm and relieved.

I was relieved because the pattern was finally broken, the pattern of hoping to see the scales at under 60kg. I was now three kilos heavier and I was still living and breathing and looking pretty much the same. You told me to go home that night, have a rest, do something fun and calming. You told me “Sami make sure that you are not going to the gym. Make sure that you do not restrict your food intake. Remember that regular eating is the most reliable way of keeping your weight stable and making sure that every time anorexia tries to take over that you can look at him as a drunken guy on the other side of the street and ignore him and keep walking”.

I had my gym bag in the car because I had planned to go to the gym that evening but when I left your office I was exhausted and decided to follow your advice and go straight home. I was tired and embarrassed for putting on three kilos. I was blaming everyone for my weight gain. It took me weeks and weeks to get used to my new weight. I was having nightmares about it but I kept going. I was so tired that another relapse would have required too much energy to even contemplate. I was losing everything, my mind, my emotions, my partner, my parents, my siblings, my friends, my passion for life, my smile and my happiness. I was losing them all. I was tired of disappointing everyone specially you and my boyfriend.

From March onwards after almost a year in therapy and disliking you for so long I started looking forward to seeing you. I realised finally that, yes, you had my best interest in mind. I realised you were not an enemy. You became my best friend and with your voice at the back my mind about the drunken guy and regular eating I kept going. I was going through so many different emotions every week and after each meal but I knew that I had a session coming up very soon so I could talk to you about it. I decided to trust you (after one year) and that was the best decision I have ever made in my life. I was terrified of getting weighed every week but you sat there and talked to me for 15 minutes before the weighing to make me calm and prepared. You tried every single way to show me that my weight gain was not radical at all. Using a chart was very effective especially showing me a straight line with your little pen every time to assure me that my weight had been stable for three months. This was always reassuring.

Roger, your patience and your caring approach has saved me. Relapse after relapse, you never judged me but instead you looked at me with kindness and care and picked me up again and again. You were not only just my doctor and my therapist. Instead you became the most trusted person in my life and the worst enemy for anorexia. In those early days I never thought in a million years that you would be able to succeed and I kept saying to myself ‘Roger is wasting his time’. I still don’t know how, but somehow you managed to turn everything around.

Am I fully recovered? No I am still recovering and I still need your help and support. Am I happier than seven months ago? Absolutely. I am getting more and more comfortable with my weight. I am relieved that finally I might have reached my set weight point. I now know that there is more to life than keeping my weight down. I now know that you were right that I could not control anorexia. I could not have anorexia and carry on living a normal life. You told me once; “Sami, living with anorexia is like saying to yourself ‘I can live with a little bit of cancer happily ever after’”. I remember everything that you have told me and I remind myself of your very wise advice on a daily basis. I thought at the beginning that I could stop being anorexic at any time I wanted to stop. I thought I could just switch it off but I was deluded. I would not have been able to get to this point without your help. Looking back it would have been absolutely impossible. I was very lucky that I was forced into seeing you in the early stage of anorexia. I will be forever grateful to Dr M for introducing you to me and forever grateful to my boyfriend for pushing me into seeing you time after time.

You saved me from this demon that is called anorexia. I turned into a demon for more than a year and I have hurt so many people in my life. I have hurt myself more than anyone else. I wasted two years of my life. I lived in agony and I was miserable. I resisted every single piece of advice you gave me at the beginning. I resisted putting on weight. I resisted eating the forbidden food on my list. I ignored your advice not to exercise for hours and hours. I counted my steps. I bought size 6 or extra small clothes. I refused to accept that I could not be in control of anorexia. I refused to see how caring and concerned you were. I refused to trust you for so long.

But then I stopped resisting, ignoring and refusing and I did everything you asked me to do. I did put on weight. I did eat all the forbidden food in my list. I stopped exercising for hours and hours. I deleted the step counter on my phone. I gave away all my size 6 or extra small clothes. I started caring for myself. I started ignoring the demon and every day I reminded myself of what you had said, “Sami, anorexia is like a drunken guy on the other side of the street. Ignore him and keep walking. Sami, regular eating is the only way to reach a stable weight. Sami, there is more to life than being obsessed with your weight. Sami, the number on the scales is only a figure. Your weight can fluctuate by one kilo in one day. Think about the things you can achieve by not having anorexia”.

I have now done everything that I resisted for so long and I am still living and breathing, I am smiling again. I am happy again and I have things to think about other than food and my weight. Seeing the figure on the scales does not scare me anymore. It gives me a moment of anxiety but the difference is that I won’t then sweat over it anymore. That’s the way it is and the new figure (which is not as low as before) is a part of my happiness and my new approach to health and well-being.

I could not have achieved what I have achieved without your help. Had I not accepted professional help I would have drowned deeper and deeper and the future would have been horribly really bleak for me. I will endeavour to use my experience to help people stuck with the demon as in my humble opinion recovery is not possible without professional help.

You told me the first day that recovery is possible and you were right, I have come a long way and I will keep going. You did not push me. You walked along side me and I will forever be grateful to you. I owe you my life and every single achievement in the future. I look forward to seeing you until the day that the demon is completely gone.

Your forever grateful patient
Sami ☺

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