SICK ENOUGH

Picture this…You accompany your loved one to the doctor. Once there the doctor comes in to tell your loved one they have high blood sugar; in the diabetic range. The doctor goes over the diagnosis, offers the aid of a dietician and begins to write a prescription. You feel for your friend and are thinking of ways you can help them when you hear them say, “oh, don’t bother with the prescription, I don’t need it.”

The doctor looks up, confused, and tries to explain that it is imperative that they take the prescription but your loved one is adamant they don’t need it. They feel fine. The doctor begs them to at least see the dietician a few times to learn about glucose and blood sugar and diabetes. Your loved one turns him down again saying they couldn’t possibly take the place of someone who REALLY needs the help. Someone really sick. After all, they explain, they work, they take care of their home, they couldn’t possibly be THAT sick. The doctor leaves in defeat. You turn to them in confusion, “why are you not taking the medicine?”

“I just do not feel sick enough to get help when other people need it so much more than me. I am sure there are so many people whose blood sugar is so much worse than mine. Honestly, I feel fine.”

Sounds ridiculous, right?

Well, ALMOST ALL people with anorexia will feel this same way at some point. Many people will feel this way throughout their entire illness, and throughout recovery as well. In fact so many people feel this way, and it is such a prevalent problem, that the community has a name for it, it is simply known as “sick enough”.

“Sick enough” is a term used in the eating disorder community that refers to a feeling the person with anorexia has that they are not worthy of care and treatment. The reasons the person gives for not being worthy of care and treatment are many. Maybe they say they are not at a low enough weight. Perhaps they feel as though they have not been suffering long enough. They might refer to the fact that they feel as though they are still functional at home and/or work. Perhaps the sufferer has had bloodwork come back normal. They may have loved ones in their lives telling them they are doing good or better. They may have a body size that falls into the ‘healthy’ weight range according to western medicine. They may be able to eat some days thus feeling like they must be normal (and not sick enough). There are as many reasons people give for feeling not “sick enough” as there are people sick with eating disorders. We have a myriad of reasons why we don’t need help but the mere fact that most all of us with an eating disorder feel not “sick enough” points to it being more than sheer coincidence.

We know that anorexia is caused because our body has an evolutionary adaptation to famine. When this genetic ‘switch’ is turned on due to energy deficit a cascade of changes happen within our bodies. Some of these changes make us feel like we need to keep our bodies moving. Other changes make us feel good when we restrict food. Not only do we feel good when we restrict food, we feel disgusting and bad if we do eat. When starving the hormonal shifts in our body make us feel more focused, in control, strong, and powerful. Still more changes in our brains cause us to hallucinate fat stores on our body. These changes are imperative for someone who is needing to migrate a long distance because of famine. But today, when there is no real famine, and we are actually dying, these changes also make us feel as though we are just not “sick enough” to deserve help or recovery.

People with anorexia do not feel “sick enough” because, put simply, we do not feel sick. We are fulfilling the mission of migration, and while we do, we have this background music in our heads telling us constantly that the restriction, the moving, the behaviors, are all the means to the end for survival. We see other people around us and we can view their emaciated bodies, yet we can’t see our own. We can point out when others do not eat enough calories, yet fail to realize we ourselves are starving to death. We notice that others are working out too often but for us; we are just ‘healthy’, or preparing for a marathon, or getting those steps in. Most of the time we simply do not feel sick enough for help. This is a normal pattern of thought for someone with anorexia. We CAN see sickness in others….we CAN’T see it in ourselves. Therefore it follows that if we see others as sicker than us, we cannot be “sick enough”. To simplify all of this is to say; THERE ARE ABSOLUTE REAL BIOLOGICAL REASONS WE FEEL NOT “SICK ENOUGH”.

Now let me say also, of course there are the times when we do start to see our sick selves here and there. We are shocked and start to wonder if we do need help, if we do deserve help, if perhaps we are sick after all. This happens because despite all the changes anorexia has made to our bodies our true selves are in there somewhere. Our true selves peek out now and then to remind us that anorexia is lying, there is no famine, the migration is all for naught and it is safe to seek help. Even when this happens though, anorexia’s biological changes are still there to remind us that we managed a normalish meal yesterday, or we were able to skip a run this morning, thus proving that we must be normal, that we must not have anorexia, and we are still not “sick enough”.

While our genetic ‘switch’ for anorexia is turned on we will always be looking at the world and ourselves through the lens of the anorexia. It is only by trudging through recovery will you begin to bring those anorexic imbalances in your body back into balance with your real self. There will be a time where you feel not “sick enough”, but somewhere deep inside you will hear a little voice, your true voice, telling you that you are sick enough. Fight for that little voice. She needs space to grow. There will be times when you are moving forward on blind faith alone, as anorexia will drown out your true self every chance she gets. After all, you’re not “sick enough”, anorexia will say. It will feel like she is right, but remember, anorexia is just a mixture of messed up brain chemistry and hormones…..much like a toddler screaming and crying because they want to run into a freezing ocean. You would not listen to a toddler and let them run into the ocean, why would you listen to anorexia?

As you disobey anorexia, and you gain weight, your hormones will begin to balance again. Your true voice will get louder. As you keep moving in recovery you WILL slowly watch as anorexia becomes the little voice. And as anorexia becomes a whisper so will the words not “sick enough”. Because your true self knows you are sick enough. No one recovers to still believe they were not “sick enough” because not being “sick enough” is just another of a long line of anorexia’s lies.

T