“ANYTIME”…BUT NOT NOW

My ears pricked as I heard a line from the conversation from two women sitting on the two stools beside me in the café. A simple question: “How are you doing?”

 

So ordinary but it stood out. I’d been typing away from my perch for fifteen minutes. The women had preceded my arrival. A lovely back-and-forth between two women in their early seventies. It was clear they were catching up after some time apart. Every so often, one of the women would drop the f-bomb and I kinda loved it. Not delivered with rage. Same conversational tone. But refreshingly unexpected. Human. Be the seventy-something you want to be. 

 

When “How are you doing?” pops up mid-conversation instead of at the start, it means something. It’s not a throwaway alt version of hello. “Fine” or “Good” doesn’t seem to be the acceptable response. Confirming this hunch, I heard the questioner follow with a quick add-on: “Is it okay that I ask?”

 

A few words like sleep and treatment dotted a lengthy response. I made the assumption cancer was in there too, expressly or implied. My ears shut down. They knew this was private. They knew the period of being amused over f-bombs had passed. If another followed, the delivery would be much different. 

 

Oh, how I would love a mid-chat “How are you doing?” It doesn’t come. I can almost see the person I’m with doing an artful dance around it. Let’s maintain some levity, shall we? Laughter is good medicine, after all. Even when forced. 

 

So many topics. Pick from the following:

A.      “Unseasonable” weather

B.      Recent travels

C.      The Tony Awards (even though neither of us 

         has been to NYC this year)

D.      Any Trump trial

 

Hell, even Gaza or Ukraine will do. Anything but a meaningful “How are you doing?”

 

I totally get that a person with cancer doesn’t want every conversation to be dominated or interrupted by the topic. Sometimes it’s nice to instead posit whether Dua Lipa will have the staying power of Lady Gaga (Hope so.) or even talk about whether Edmonton can make the ultimate comeback in the NHL finals (Shrug.). That’s why the woman’s “Is it okay that I ask?” was a perfect followup. Her companion’s reply: “Of course!”

 

Ask me. 

 

Someone. Anyone.

 

I don’t have cancer. Cancer sucks. F-bomb that. In my family, it was a taboo topic with an asterisk, that little star meaning it wasn’t to be discussed with the person with cancer but was open for discussion with anyone else, a trickle down of intel acquired somehow—did someone break taboo or was it all speculation. I mean, just look at her. 

 

It wasn’t just my family that played things hush-hush. Laura Linney starred for four seasons in a Showtime series called The Big C. To be clear, the nasty c-word was cancer, not the nastier other c-word. I’m perfectly comfortable talking cancer; the other word? Nope. Never. Not even a men’s locker room. (Another c-word comes to mind: cavemen.) 

 

We are getting better at talking directly about tough physical health conditions. Cancer. COVID. AIDS versus HIV. It’s partly because I’m a guy of a certain age but colonoscopy has come up in conversation a few times in the past year. I’m not skittish about the topic, just procedure-averse. Any procedure. I’ll still ask questions. It’s part of acknowledging my friend, inquiring about what he’s going through and whether he has any concerns. A colonoscopy conversation sounds more pressing than his take on the Tony Awards. Let’s talk…if that’s what you need. 

 

The taboo is still entrenched when it comes to mental health. Every time another celebrity comes out about an experience with clinical depression, being bipolar or having an eating disorder, I feel hope just as I did thirty years ago when some famous person came out as gay. 

 

It’s not just me. 

 

There is a public name and face for this “quirk.” Regarding anorexia nervosa, few male celebrities have come forward. (Zayn Malik has referred to food restriction while part of One Direction but the oft-repeated quotes do not include a specific diagnosis. Not so helpful. It doesn’t bring a conversation forward. It’s the equivalent to if George Michael said in 1990 that he’d crushed on a guy. What exactly is that…if anything?)

 

Labels matter. Until they don’t. 

 

Me saying I’m gay? These days, so what. Anorexic? Um…How ’bout dem Tonys?

 

My current downward spiral into severe food restriction—beyond my normal restriction practice—began March 25. This is Day 86, an uninterrupted streak. I’m down to the last hole in my belt, a shift of four holes. My face is gaunt, my arms and legs significantly thinner. So much of the muscle gained through decades of disciplined gym workouts is gone even as I continue the same workouts. Muscle is lost before fat. 

 

There was a point during this streak when my body looked “hot.” Six pack, body fat presumably negligible. (I never weigh myself. When I must step on a scale at a doctor’s office, I close my eyes or stand backwards on the device. I’m very clear with the medical provider: Do not tell me my weight. If I know a number, it feeds into a warped game—how low can I go?)

 

I’m well past the point of “hot.” Now I try not to look because sometimes the sight in the mirror makes me cry. I’m doing damage. I can’t stop.

 

Someone who doesn’t have any understanding of eating disorders could easily say, “Just eat something.” A donut. Two. A lunch. A carrot. Hell, a “baby” carrot.

 

The understanding isn’t there because this is a food-obsessed society. I’m more aware of this when I’m in a phase of severe food restriction. Food is all around me. Ads. Signage. Tossed cups and wrappers. Restaurants. Grocery stores. Overheard conversations. The pair of seventy-somethings have left and, at this moment, sitting beside me, two young women have been talking for fifteen minutes about avocado toast, omelets, fried eggs and poached eggs. On and on and on…It’s progressed to “favorite chocolate bar.” This is what friends are willing to talk about. This is much more in the realm of normal than my current state. 

 

Sights. Smells. Imagined tastes plant themselves on my tongue.

 

I’m on a 3-4 month wait list for outpatient support despite having been officially diagnosed by several psychiatrists, assessing me independently of one another. I’ve previously had an extended hospitalization. I’ve been in a group home. 

 

The referral process started at zero again. 

 

So it’ll be September, maybe October before another round of the same ol’ outpatient oversight. I didn’t buy into before as part of an I’ll-try-anything twenty-one month period in 2018 and 2019. I’m not all that hopeful anything will resonate this time around. But I won’t be alone with this. All the group sessions will be filled with people like me. Sort of. People with eating disorders, at least. Women. Under thirty. But I’ll see and feel their nods as I talk. I’ll nod for them, too. The nods won’t be formalities. Instead, they will mean, I see you; I hear you. 

 

If I continue on the current path, I may wind up in Emergency first.  

 

Again, I can’t stop. Despite what I know rationally, the eating disorder owns me. It’s scary. It’s sad.

 

Whereas people with active eating disorder behaviors typically go to extremes to be secretive, I am open. I am hiding nothing. I have previously opened up in an essay published by CBC, in a podcast and as being the patient on a panel for Toronto nursing students (my co-panelists being a professor and a social worker). If I talk, it may help another guy who is struggling. Maybe he’ll seek help. Maybe interventions will come sooner. Maybe his habits won’t be ingrained over four decades before an initial diagnosis. Maybe he’ll move past it.

 

Right now, I’d love to talk, to be heard, to have someone ask away about what they don’t know or understand. Maybe my conversation will break down stigma and allow that person to “be there” to listen and support someone else…and maybe help me just by letting me babble for a few minutes, feeling heard, feeling less freakish, feeling less alone in all this.  

 

I’ve mentioned to my friends around me I’m struggling. The response is always the same, an empathetic spiel something like the following:

Oh, I’m so sorry. That’s awful. I’m here for you, you know? If you ever need to talk about it—anytime—know that you can talk to me. [Pause to catch a breath.] By the way, did you see The Tony Awards? I’m so glad Daniel Radcliffe won. Aren’t you?

 

No lie. A bizarre segue happens. Every. Single. Time.

 

This is what makes people give up. This is one-sided affirmation. What a good person for offering an ear. Not now, of course. But someday. As long as it remains indefinite, in the future, always beyond reach. 

 

I, in fact, feel worse from this demonstration. I know these are good people. I don’t have tolerance for people who aren’t. But they can’t handle it. Just the topic of mental health is too foreign, too scary, too taboo. 

 

If I hadn’t shared, I could have floated the possibility that Joe or Sue might be supportive. Someday, yes, in the future, always beyond reach. Instead, another door is shut.

 

A dream scenario...

I’m more alone in this just from raising the subject. 

 

How am I doing?

 

Fine.

 

Do you think these gray skies will ever go away?

 

 

 

 

NOW PLAYING, CENTER STAGE: AN EATING DISORDER

May is Mental Health Awareness Month. For myself, the awareness is a daily experience. Even on a good day, a worry will pop up—often—that a new chance to unravel could be moments away. The slightest glitch can do it. I hate when I crumble. I fight to be resilient. Sometimes, all I can do is surrender and wait things out. Things do pass.

 

I’m deep into a stint where my eating disorder has taken charge. It’s not altogether unwelcome. I journaled what appears below near the point when it shifted into higher gear. I thought it might have passed by now but this is Day 51. I have reached out for support but there’s a wait list. The thoughts and behaviors go on. I’m okay-ish for now. 

 

I’ve decided to post this because maybe it will help a reader understand what a friend, relative or colleague experiences. Perhaps it helps enlighten someone about the fact older, not-so-thin men can have an eating disorder, too. Maybe someone will recognize their struggle and begin the process for seeking help as well. 

 

To an outsider, the solution is maddeningly simple: eat something. I know this. I can tell myself this. However, it’s like telling someone who is clinically depressed to just smile. Cue Bobby McFerrin: Don’t Worry, Be Happy. Mental health, however, doesn’t correspond with a meme or a Hallmark card. 

 

March 31, 2024

It's another Easter weekend and I'm struggling. Easter is the longest weekend on the Canadian calendar. Things shut down for Good Friday throughout the weekend and for Easter Monday. This was especially problematic a decade ago in 2014 when I found myself admitted to the psych ward at Saint Paul's Hospital on a Thursday afternoon which just so happened to be the day before Good Friday. Ever since, Easter makes me feel uncomfortable. That stint in the psych ward left me with heightened anxiety and PTSD since the only bed they could place me in for that long weekend was in the most severe psych ward. (It had never dawned on me that a hospital would have multiple psych wards.) I was scared, I feared for my safety, I desperately wanted out and, having no control being involuntarily committed, the entire experience spiked my eating disorder behaviors.

 

It's not because it is once again Easter nor is it because this is the decade anniversary, but I am once again in the midst of a spiked eating disorder situation. This is day 7. I didn't plan this, but something about last Monday had me so busy that I missed lunch. I don't eat breakfast. Lunch is when my body finally receives a little fuel—cottage cheese or yogurt; rice cakes. Everything is limited and controlled. But having missed the lunch mark, it became a warped game. It was already 2:00 in the afternoon. I could clearly go without eating lunch. I could wait until 5:00. Dinner. A single meal. 5:00 came and went. I knew if I delayed dinner, I wouldn't have an evening snack as well. There would be a significant drop in my caloric intake for the day. This was victory. I was winning my game.

 

With the win on Monday, I decided to make it a streak. Let's go for Tuesday. Mission accomplished. Same for Wednesday, even though I swam 5 kilometers that morning, my maximum distance in the pool which I hadn't done in over a year. Usually, I am famished after a swim workout. My body craves carbs to restore whatever I swam off. But, no. One meal once again. Thursday, Friday, same.

 

This was easy. If I smiled, the smugness would show. I am in control. Not of life. That's a mess. I am still shocked and saddened by being dumped six weeks ago after a two-year relationship I thought would last. I feel especially alone here in Vancouver. My best friend moved to Montreal four months ago. 

 

I can no longer relate to my closest friend who still lives here. Every time I see him, the experience rings false. He launches into a monologue about a new hobby, a long-winded recitation I sense he has repeated many, many times to other people. It used to be about mushroom videos on YouTube. Zero interest from me. More recently, it became about fermenting onions and other vegetables. Zero interest from me. During our latest catch-up, he arrived uncharacteristically late, hauling a five-pound bag of sugar. His grand new hobby: making vinegar from scratch. Dear God, help me.

 

So, yeah, he is not someone I can lean on. Other friends seem to have disappeared. They have families, one is still dealing with the death of her spouse; another is so passive he never ever is the one to reach out to do something. I am as alone in this city and in this life as I have ever been.

 

I do not know how to change this. I am stuck. I can do nothing to get my relationship back. I don't have any idea how, at 59 years old, I can go out and make new friends. Good friends. People I could lean on. 

 

My immediate family is not helpful. “Get a dog.” That’s their solution to getting over a bad breakup, not that they have any sense of how bad it’s been. There is no depth of conversation about the loss I have experienced. It’s par. They just don't go deep. It does not seem to be within them. They have all been in longstanding relationships, decades and decades of anniversaries celebrated. They understand very little about me being gay—that would require conversations and questions. They understand less about my habitual boomeranging to singlehood.

 

He loves me. He loves me not. 

 

Some poor little flower got all its petals plucked. The City of Vancouver should take out a restraining order, keeping me a hundred meters away from all garden spaces.

 

So yes, hello anorexia nervosa. It has always been there with me. This is one of those times, however, when it is taking centre stage. It has the power. I have given it that power. 

 

Yesterday morning, I was in a different part of the city to get my haircut. I brought my backpack, slipping in my laptop and two canvas bags. A health food grocery store I love is a block away from the salon and I figured I would pick up some of my favorite products while in the area.

 

I entered the grocery store and was immediately confused. I'm not eating much at the moment. Should I even grab a hand basket? I hesitated, then took one. Maybe just holding the basket would encourage me to buy more items. 

 

As I walked down the first aisle, one of the dangling tags indicated a box of wafer crackers was on sale. I buy these crackers on occasion. I stopped and stared at them. It became a dilemma. Do I want these crackers? When would I eat them? My sense was I didn't want them. I certainly didn't need them. I put the box in the basket nonetheless. Let this be the start to my grocery haul. I picked up nothing else from that aisle nor the next. 

 

I glanced in frozen foods windows. Ice cream registered in my brain. Usually, a pint or three of Häagen-Dazs or Ben & Jerry’s become an irresistible temptation. Sometimes, I load up so many, I feel obliged to lie to the checkout clerk. “Having a little ice cream social.” 

 

I had no desire for ice cream. I had no desire for anything. As I reached the last aisle, I stopped again. I stared down a container of non-fat cottage cheese. This is the only store I know in Vancouver that still carries it. I do not like the taste of 1% or 2% fat cottage cheese. It tastes heavy, it tastes gross. This was my chance to get the cottage cheese I like. I checked the expiration date: April 27. It was good for a whole month. Still, I questioned whether I would be able to eat it before then. I put the container in my basket, a companion for the crackers.

 

I perused the fresh vegetables and fruit. Nothing appealed to me. I had gone through the entire store and picked up two items. I had my two canvas bags in my backpack. I suppose that meant one item in each bag. A very balanced walk home. I headed toward the checkout. I glanced down at the two items in my basket. No, I did not want them. I did not need them.

 

I went back to the dairy aisle to return the cottage cheese, then went to the other end of the store to place the box of crackers on the shelf where I had gotten it. I put the basket back in the stack of empty ones by the entrance and left.

 

Grocery stores have given me many problems over the years. I often become anxious in them for reasons I don't fully understand. But this was the first time I walked all the way through a grocery store having planned to buy food and then consciously decided to not buy anything. On the sidewalk, I felt stunned. I knew this was a problem. But nothing was going to change my decision. I walked a couple blocks farther from home, stepped in a favourite café, ordered an oat latte and had a writing session. Keeping with my new routine, coffee with oat milk is all I consume until my evening meal. 

 

Walking home, I passed that grocery store again along with two others where I frequently shop. Generally, I like going into grocery stores farther from home to pick up items on sale, to save a few bucks. I get this from my father. He is a man who glories in a bargain. He stocks up anytime any item he might possibly want to consume in the years ahead is on sale. This is a coup to him.

 

No. Grocery. Shopping. 

 

I realized I had a lot of food at home and I didn't know how I was ever going to eat it all. I passed bakeries, a donut shop, two of my ex’s favorite eating spots, a vegan restaurant I love. When would I ever go into any of these places again? In only one week, food had become the object of my rejection.

 

Still many blocks from home, I felt weak. I felt panicky. I didn't know if I could make it back to my place. I was vaguely aware of an emergency vehicle passing by me in the street. Not a police car; maybe an ambulance, maybe one of those smaller red trucks the fire department uses. It dawned on me after the fact that maybe I should have flagged it down. Maybe I really needed a ride back home. Maybe it was even an emergency. 

 

You can't tell if someone has an ED
just by looking at them or checking
their weight.

Although scared, I knew this would not be enough to change the level of restriction I am on. As I walked, I leaned into one of my regular distractions. I stopped and took a selfie against a background that matched my shirt. Usually, I do this for amusement. In the moment, however, it gave me a chance to pause and also a break from thinking about the struggle the walk was becoming. 

 

I walked down an alley I knew had a great deal of graffiti. I looked for more backgrounds to take more selfies. Then I continued the walk. With only a few blocks left, I was very weak, but I could make it. 

 

Despite this experience, I knew that after sitting on the sofa for a little while, I still had a three-hour workout to do involving ab crunches, time on the exercise bike and using weights to focus on working out my chest. This would not be compromised. In fact, I shortened my rest on the sofa, got up and got started with the workout. I didn't want a delay to make me complacent, to make me back out of the exercise I required of myself. 

 

All this is fucked up. I know it. 

 

I can't stop it.

**

IF YOU NEED HELP...See your doctor. Tell the doctor EVERYTHING. (People with eating disorders tend to minimize things or be secretive.) If the doctor dismisses your concerns (as first happened to me), get a second opinion. Don't settle for or freak out over whatever Google says. Seek actual supports in your community. 

If it feels like an emergency, go to Emergency at your nearest hospital. 

 

STILL GOT IT

A year ago today, I checked into a group home, beginning a thirteen-week program alongside seven other people with eating disorders, hoping that I might finally end all the self-hatred about my body (and the rest of myself).

My meals were monitored, with portions measured out to make sure I was taking in enough of the right kinds of foods. The program strove to introduce me to a new way of looking at food, replacing four decades of fearing meals and restricting my intake. Through a reduced exercise regimen that permitted only five one-hour workouts per week, my body was supposed to recover from being constantly overworked, part of an endlessly desperate attempt to work off calories, love handles and an oversized belly that existed, I am told, more in my mind than in reality. While some people with eating disorders have bulimia and throw up foods they binge, exercise has been my way of purging anything that I considered to be harmful intake.

With the other residents, I attended a hospital program four days a week, a combination of individual sessions with a psychiatrist, a psychologist and a dietitian and group sessions led by a rotating team of professionals.

A year earlier, I’d belonged to an out-patient provincial eating disorders program, picking and choosing various courses and making absolutely no progress. I resisted everything. My eating disorder had become my way of coping with the uncertainties of life. I may not have been able to control external factors, but I’d mastered how to control my body. If I forfeited my eating disorder, I suppose the thinking was that I’d be left with chaos. Instead of forgiveness and self-acceptance, I would experience a spike in self-hatred. There was no chance I’d make progress in a casual program. I knew I was a complex piece of work and I begged to be admitted to the group home program.

I contend that my eating disordered thoughts and behaviors became deeply entrenched because it took so long for me to be diagnosed. I’m far from the prototype for an eating disorder. My body has only looked like what you’d see on an eating disorder poster a few times in my life. Usually, I feel certain that my body needs to lose weight and that it’s not just in my head...anybody would see that if I ever strayed from the baggy clothes styles that came into fashion in the ‘80s.

I’m male and men are under-diagnosed for eating disorders. I grew up seeing photos of emaciated teenage girls and knowing that Karen Carpenter died from an eating disorder. It was a feminized condition.

My family doctor missed it—even when I said outright, “I think I’m anorexic.” The doctors and psychiatrists in the psych ward missed it, even as nurses complained about me refusing to eat and doctors assigned me daily consultations with dietitians (whom I stressed out) and brought in a cardiologist due to abnormalities with my heart.

I was well beyond my teens when I was finally diagnosed; I was fifty-three. This was not part of some midlife crisis. My symptoms first appeared before I reached my teens. I offer this background information to illustrate why I’m still conflicted over my eating disorder diagnosis. I’m the “wrong” age, “wrong” gender and “wrong” weight.

While in programs, I glance at protruding collar bones and frail arms of young women sitting across from me and I have to fight the feeling that I’m an impostor. Most programs have wait lists and I feel I’m taking up a space that should be for someone with more urgent needs. I regularly share this with professionals and they always assure me that I belong. (Gee, is that a good thing?) In fact, they denied my repeated requests to be put on the wait list for the group home because the team felt I wasn’t ready. I would fail without first being admitted to a more intensive seven-week in-patient hospital program. That required another wait list. All along, I asserted that the hospital program was wrong for me and it was with a twisted sense of triumph that I went through that whole thing making zero progress.

Ha! Told you so.

As it turned out, the group home experience didn’t work out either. My mood crashed. I battled with the dietitian. (Taking away my cottage cheese and forcing me to eat peanut butter felt very threatening!) Just as in the hospital program, I lost any sense of independence, my writing routine—my life’s passion—almost disappeared and other immature, attention-seeking personalities in the house became a huge distraction. I made the decision to leave after five weeks.

And now, a year later, my eating disorder is on autopilot. My one slight victory was that, since the hospital admission ended in May 2019, I’d stuck to a slightly reduced exercise schedule—much more than allowed in the hospital or the group home, but a bit less than my prior standards. All that slipped away a few weeks ago. I’m relishing exercise, even as some injuries have popped up recently. Just do it, my brain says. (Thanks for that, Nike.)

All ties to the professionals at the hospital ended the day I withdrew from the group home. I attended one more course as part of the provincial out-patient program but, per protocol—largely due to funding, I presume—I was exited from all supports connected to that program last December. After a three-month “stepping out”, I was allowed to refer myself back into the program, but I didn’t do so because I’d planned to move out of province...until COVID-19 came along and sidelined all that.

With more than six months passing, I now require a completely new referral for any kind of support. I’ve decided to wait on that. I could still move so it doesn’t seem the right time to re-invest. Moreover, the services would like be through Zoom and, while convenient, I know I need to physically show up if I’m really going to commit.

And that’s the biggest issue. I’m not ready to commit again. I know I still need help but I’m not ready to change. Another program would only mean another failure and that would only be a win for the pesky eating disorder. More entrenchment. You can’t beat me!

As I write this, my stomach is calling for food. It’s not even a growl as my body has gotten used to prolonged periods of fasting. A meal is still hours away. A big run comes first. (Weirdly, when I exercise, all feelings of hunger disappear.)

One year later. No better, no worse. I could say I’m learning to live with this, but the truth is, I accomplished that ages ago. I hold out hope that the time will come when I am tired of all this—thought I’d reached that point by the beginning of 2019, but I was wrong.

Change is possible. Someday.

ANOTHER ROUND

Here I go again. A new day, waking up in a strange bed. I wish there were a more exciting circumstance but, no, I get up, shower and experience a different walk of shame. No wondering about whether some guy will text me, no worrying that this is just a one-off. I have absolute certainty that I’ll wake up in the same bed tomorrow and the morning after that. It will be the same routine for the next fourteen weeks. And then, for better or for worse, it will all be over.

There’s no other guy involved. This is my own doing. I moved into a group home yesterday for another crack at treating my eating disorder. On the surface, it’s all perfectly tolerable, possibly even a great gig. I’m only five kilometers from my condo but now, instead of being in the bustle of the seedier part of downtown Vancouver, I’m smack in the middle of a charming neighborhood of older character homes and shaded parks. I’m a block from Commercial Drive, the city’s Little Italy, dotted with cafes competing to serve up the best cappuccino and all sorts of trendy new restaurants that have strayed from the lasagne-fettucine script and now offer Lebanese, Ethiopian and Japanese fare. If only eating out had some appeal.

As good as it may all seem, I can’t shake the fact that this is not normal. Fifty-somethings don’t flit off to three months of summer camp in the city. They get to sleep in their own bed whenever they want. They don’t go for programming at a hospital four days a week. They don’t have their meals monitored. They don’t have restrictions placed on how much exercise is acceptable. What fifty-year-old man has his exercise limited?!

The confusing thing to others—and even to me—is that I don’t look the part of someone with an eating disorder. I’m not eerily thin. I’d say I’m actually having to fight that middle-aged belly bulge that most men get. I’m consumed with fear that I am repulsively fat. I obsess over belly watching when in public, noting all the stomachs that may be bigger than mine, trying to take some comfort in the notion that mine might be less prominent and desperately wanting to assure myself that my tummy is normal for a guy my age. But the sense I have, at least now, is it will never be okay.

Prior to my group home gig, I spent an inordinate amount of time each day ignoring hunger cues and pushing myself to exercise longer, harder. In a way, I’m an eating disorder failure—massively blistered feet, worn out body, significant food deprivation and still no results. Not enough weight loss, not a trace of muscle gain. So much effort with nothing to show for it. A rational person would abandon a regimen that doesn’t produce results.

Drastic thoughts about my body image directly chip away at my self-esteem. Being in a group home for three months—regardless of the pleasant surroundings—is wildly threatening. With my exercise reduced to only five one-hour sessions per week and a meal plan that requires me to eat three meals and three snacks per day, it pokes at all my fears of gaining belly weight, going flabby and never being able to correct the “damage” done.

There’s another fear, a deeper one. What if I don’t see significant weight gain and, despite the encouraging evidence, I return to my extreme routines anyway? After all, this eating disorder is a fierce beast. In the spring, I spent six weeks in hospital for another treatment program. Upon discharge, I immediately went back to my eating disordered routines. I fretted that I’d gone flabby. I lost five pounds in the month between programs and the news made me giddy. This from a guy who, due to medications and moods, had thought he’d lost his ability to laugh. “It will never be enough,” the dietitian told me, referring to my weight loss intentions. Still, I wonder if the same goes for treatment.

Much of the work in program is intended to examine the underlying thoughts, emotions and events that brought on the eating disorder and continue to feed into it. I meet one-on-one each week with a psychiatrist, a psychologist and a dietitian and participate in multiple group sessions with the other residents each day. The feedback I got from the team working with me in hospital was that I’m a tough nut to crack. There were no insights, no breakthroughs. What if I can’t dig deeper? What if my sharing remains vague and evasive? How successful can I be at changing entrenched habits if I never chip away at what drives them?

I feel great pressure for treatment to work while also having no confidence that it will. What if I go through all this—the hospitalization, the group home experience, essentially half a year of intervention—and nothing changes? My eating disorder behaviors go back more than forty years and, while I’ve only been receiving treatment for the past two years, this feels like my last shot. Please don’t let this extended adult camp experiment be all for naught.