Elizabeth Sulis Kim (Photo: Michael Vince)
Elizabeth Sulis Kim (Photo: Michael Vince)
Elizabeth Sulis Kim (Photo: Michael Vince)

MIND

My anorexia isn’t visible anymore, but it’s still a part of me

Even after our physical bodies recover, eating disorders remain a part of them. Elizabeth Sulis Kim tells her story

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By Elizabeth Sulis Kim on

Thirteen years ago, I woke up in an ambulance. A paramedic was checking my vital signs. “Low blood pressure, bradycardia,” he said. He’d pricked my finger and had difficulty squeezing the blood out. He saw me looking at him from the stretcher. “Very low glucose levels.” The man looked troubled when he caught my eye.

Did I look ill? I didn’t feel as though I did. Yet, in those days, I would catch strangers looking at me when they thought I couldn’t see. It didn’t matter to me, either way. It was late at night and I could feel every bump on the country road. Soon we’d be somewhere else.

Minutes passed, during which I felt like I was in one of those hyperreal dreams. Then the man broke the silence: “You know, every day I see people who have had accidents, who live with chronic illnesses. And then you did this to yourself." His tone wasn’t entirely unsympathetic. He sounded frustrated more than anything. I was used to this and I didn’t have the energy to respond. I closed my eyes and breathed in the gas and air.

In the year preceding this event, I’d seen my fingernails turn blue and my hair blow away in the wind. My periods stopped and soft downy hair appeared on my taut face. I felt very little at the time; I just watched passively as my thoughts changed and my body followed suit. Instead of emotions, I thought in terms of numbers. I lived by the clock, calorie counts and the plummeting figure on the scale. Anorexia creeps up on you stealthily. By the time you become aware of it, it’s difficult to shake off the habit. I found myself subservient to a voice in my head that made me do things I didn’t like. If I felt one thing, it was that I wanted a long and uninterrupted sleep.

“You’ll feel better when you gain weight,” said my doctor when I told him this during a weekly weigh-in. “Focus on recovery. Being underweight causes depression.” I thought back to my early childhood memories, where I had already experienced existential depression, and expressed my doubts. “If you find yourself feeling low in years to come, we can help you then,” he said. And so I saw a flicker of light in the dark room.

Years later, I watched my body take on new flesh. I cried in front of changing-room mirrors because my body no longer expressed what I felt inside. While hunger had numbed me to emotions, recovery made me anxious. The world is overwhelming when you recover your senses – there’s so much stimulation, so much to make you think and feel. I felt heart palpitations so strong that I cancelled social events and withdrew into myself. I was nauseous and often broke out in stress rashes. One day, during a stressful exam period, I took these feelings to a GP I didn’t know. I told her how low I was feeling and reminded her of my past history of anorexia. She looked me up and down. “Well, you look fine now,” she said. Yet, for me, anorexia wasn’t about eating or not eating. Nor was it really about self-perception. These were just symptoms. My body in that ambulance was just the physical manifestation of what was going wrong with my mind.

For me, anorexia wasn’t about eating or not eating. Nor was it really about self-perception. These were just symptoms. My body in that ambulance was just the physical manifestation of what was going wrong with my mind

Why am I writing this? This process is in some ways cathartic, but I also feel exposed. I’m revealing I have a history of “mental instability” in a society where social and institutional stigma surrounding mental-health issues still persists. In the NHS, mental-health-care providers still receive far smaller budgets than physical-health-care providers, despite ministers pledging to create “parity of esteem” in 2013. Sufferers of mental-health conditions are often made to feel guilty about what we’ve put friends and family through, as if we brought these feelings upon ourselves. I don’t blame people for not always understanding. It’s difficult for others to see what’s wrong when the vessel that carries you looks healthy.

But the mind is seldom visible on the surface. We need to be able to talk about these things openly and provide long-term support to those who need it, even after their physical bodies recover. Perceiving mental illness as a moral flaw and an indication of a lack of discipline may hinder public health interventions for preventing and treating disorders like anorexia. Relapse after recovery from anorexia nervosa is all too common. It also has the highest mortality rate of all psychiatric disorders, and suicide is the second leading cause of death among anorexia sufferers after cardiac arrest. At a healthy weight, recovered anorexics don’t necessarily have access to the same psychiatric and social support they had when underweight.

This is partly because anorexia – like many other mental-health conditions – is often thought of as a modern phenomenon confined to the developed world; it’s dismissed as a “white woman’s disorder”. This assumption is flawed. It’s thought that anorexia was first described in 1689, and we know this illness doesn’t discriminate against gender or skin colour. Research indicates that sufferers of anorexia may share some things in common. There is a growing body of research that suggests genes may play a role in the development of eating disorders. A genetic predisposition would not mean anorexia is pre-determined; like many physical conditions, its triggers are often environmental. Researchers have also identified certain personality traits that might increase the risk of developing this psychiatric condition.

Years on, I am now in remission. It makes me uncomfortable to say this so plainly, for it’s a term usually used for sufferers of life-threatening physical conditions. Finally, I can eat intuitively. I am more in touch with my emotions and can distinguish between myself and this alien voice that sometimes takes hold of me. But I know, as a former sufferer of anorexia, that I am susceptible to relapse – and I still have a black mark on my medical records. When I went to university, I never told people about these struggles. I was embarrassed and thought it a good opportunity for a fresh start. But I have realised that you can’t always write off years of your life, even if you didn’t like them. What you’ve been through becomes a part of you. This, and being open about these things, might help prevent future relapses.

Sometimes, I think back to that paramedic who told me I was doing this to myself. I wish it was that simple, but why would mental-health problems be such an issue if we could turn our problems off at will?

These days, I often take walks alone in the city. By now, I’m used to the sensory overload – I think I enjoy it more than most people. I step out into the streets and feel the heat of the sun on my skin and a certain connectedness with the strangers who pass me by. Yet life is like a river; you seldom know what obstructions you’ll encounter downstream until you get there. It would be reassuring to know you don’t have to go it alone or in silence.

@elizabethsulis

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