Food for thought

CW: eating disorder, self-harm

This post speaks in detail about disordered eating and self-harm. Please be advised before reading and exercise due caution.

Resources and help are available at HelpGuide, LifeLine, and NEDA. Also consider The Trevor Project (1-866-488-7386) and Suicide Prevention Lifeline. In South Africa, Triangle Project runs a helpline on 021-712-6699, and SADAG at 0800-567-567.

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Well, this won’t be an easy post to write. But I think it’s an important one, for a couple of different reasons.

Integrity is one of the qualities I value in life more highly than any other. Compassion is another one, of course – but that is less relevant to this particular conversation. A large part of the work do as an activist involves having to “portray” trans experience. Well, my trans experience, because I don’t have agency to portray anyone else’s. I do this because I want people who have never had those experiences to be better able to understand them – perhaps to find some commonality or some resonance that helps drive home the idea that trans, as a concept, needn’t feel so foreign. And then, of course, I do it because I know that there are people out there feeling many of the same things that I am feeling, or have felt before, and that through sharing my perspectives, they might feel less alone, or they might be able to understand their own experiences a little bit better.

In my “role” as a representative, I want to show that being trans and being successful are not mutually exclusive. Being trans and being happy. Being trans and being beautiful. Being trans and being human. That all of these can coexist. I want people to understand that trans people can be at their best when they live in their truth, that there’s nothing to fear, and nothing to hate. I want people to see the light at the end of the tunnel – the hope, the growth, the self-actualisation. And I use myself as the example, because in the time since I accepted this truth of my existence, I have achieved many successes. I’m very proud of the path that I’ve walked.

But this is a coin like any other – it has two sides. And I cannot claim to have integrity if I do not embrace both of those sides. There are uplifting and empowering experiences here, yes; but also, there is darkness and shadow. Every victory is hard won. None is without its price. To celebrate the light and ignore the dark is disingenuous, inauthentic. And I am nothing if I cannot be authentic.

Now, the things I’m about to discuss are not products of being trans, or products of transition. They interact with my trans experience – particularly my dysphoria – but they exist independently. It’s an important distinction, and I hope I’ve made it sufficiently clear.

I think many of my regular readers know by now that “happy” and “uncomplicated” are not words I’d choose to describe my childhood. I won’t detail right now all of the contributory factors – this is neither the time nor the place for that. But amidst all of the challenges that faced me as a youth, one was being overweight. I’d been rather a slight child, until I began to live with my father. By the time I was 10 or 11 years old, I was quite fat. Even today, there is still guilt and shame associated with fatness – despite the existence of movements to dismantle the stigma and the prejudice. But 20 years ago, there was nothing to dilute the shame. I do remember being ridiculed and undermined. By friends, by classmates, by family.

I don’t remember the exact time-frame – I’ve mentioned before that memories of my youth are not the clearest ones I have – but by my mid-teens, I don’t think I was overweight by objective measures. Well, my body wasn’t, anyway.

In my mind, I’ve never really stopped being fat. And there’s nothing wrong with being fat, but I’ve never stopped being any of the other things that I was conditioned to associate with it. Gross, disgusting, revolting.Weak. A failure. Inadequate. 

You know the rhetoric, don’t you?

I don’t remember the range of weights I’ve occupied in my adolescent-to-adult life, but I think it’s been somewhere between 60-something and 90-something kilograms. During high-school, I started working out, lifting weights. I didn’t want to go back to being gross, disgusting, revolting, inadequate. No, I was going to have a body I was proud of, for once.

I’d like you to bear in mind, at this juncture, that I was fighting with latent gender dysphoria at this stage, too. I didn’t know what it was, but I knew I was uncomfortable in my own skin. It was easy for me to attribute that to internalised fatphobia, of course. Why wouldn’t I feel uncomfortable in my skin, after all that had been said to me and about me? After all the things I’d been taught to believe about myself?

Of course, trying to attain a perfect male physique is a technique that many of us use when we’re trying to combat our dysphoria, be it knowingly or unknowingly.

Needless to say, I never did feel good enough. I thought it was all my own failing, though – because I never did attain that six-pack, I never did get “ripped”. I was never the Adonis I’d aspired to be.

I put a good deal of effort into this pursuit, at one stage. Tried to do the whole “five small meals a day” thing, even. I kept diaries, planned meals and workouts, all of it.

I’ve never been good at eating. Well, at eating right. I can’t remember the last time in my life that I ate regular breakfasts, except probably for that period in high school. My diet had always been a combination of too-much and too-little.

Spoiler alert – it’s kinda hard to get that right when you hate yourself.

I remember in my university years, I had anxiety about eating in front of other people. I didn’t think much of it at the time; I wrote it off as an idiosyncrasy. When I look back at it, I can see with much greater clarity that it was a symptom of these processes that had begun years prior.

From my vantage point now, with years and maturity at my back, I can see that I never learned how to have a healthy relationship with food. I can also see that I still don’t.

Many people can understand that eating has the potential to be an emotional outlet. Most commonly for me, not-eating was an emotional outlet. If I was stressed out, or depressed, I’d stop eating. I never fully understood the reasons for that – I’m sure some of it was intended as a means to punish myself, some kind of manifestation of self-harm. That seems to make sense. It’s just the kind of thing I would do.

And that pattern has been present now for as much of my adult life as I can remember. I’d go days without food – even as a medical student working 24- or 36-hour shifts, sometimes I wouldn’t eat at all.

Of course, there were times I decompensated in the other direction, and ate too much. I don’t think I ever recognised a binge for what it was, because I had such a poor understanding of what a proper relationship with food was supposed to look like. And anyway, I was always at a “healthy weight” (what a ridiculous term!), so I had that to fall back on. I was never happy with my body, of course – but I learned to ignore that. Again, a great strategy for dealing with dysphoria that had a dual-effect.

I was also pretty good at finding excuses, as you might have gathered by now. I could blame bad eating on a busy lifestyle, on the demands of university, or of being a doctor. My then-girlfriend was a “fussy” eater, and that functioned as another excuse, especially while we were cohabiting. I could choose to view my own problem patterns as a response to hers, instead of acknowledging them in their own right.

I thought the way I ate – or didn’t eat – was always just a response to what was going on in my life. And I became so used to that line of thinking that I never questioned it. That I accepted it all as “normal” (ok, that’s another word that I really hate).

Early 2016 was not good to me. There was a period of time, somewhere around April, when things became really, really bad. I was dysphoric, I was depressed. I hated myself. I had very little hope for the future. I was in an exceedingly dark space.

During this time, I decompensated, in many regards. I stopped eating. Completely. For days on end, one or two cappuccinos a day was the extent of my caloric intake. And I refused to slow down physically, either. 10,000 steps a day at least, every day. Being out and active kept me distracted, but I still couldn’t bring myself to eat. I was angry and disappointed with my body. It revolted me. I didn’t want to feed it.

If that wasn’t enough, I started cutting myself too. Something I’d never done before, never even conceived of doing. But there I was, razor blades and alcohol swabs and gauze and bandages. I wanted to bleed. I wanted to scar this flesh that had betrayed me and taken everything from me. That had made me incapable of being loved, incapable of being accepted, incapable of being human.

In April, I got as far as being able to say “disordered eating” in reference to myself.

It wasn’t until July that I was able to say “eating disorder”.

Fucking pathologisation, right? Because isn’t that the power of stigma?

As a doctor, educated in the horrific system that creates doctors, I knew all about eating disorders, didn’t I? The stigma was alive and well inside me. All those perceptions that society has of “people with eating disorders”. Maybe, if those harmful ideas hadn’t been so ingrained in me, I’d have had an easier time coming to terms with what I was facing.

It was a paradox. Because I wasn’t borderline, or bipolar, or histrionic. I had insight and judgment. I was functional – extremely functional, even – so how could it be possible?

It took me a long time to own the words. To be able to say, “I have an eating disorder”. I was scared of what it meant about me, what other people would think. That didn’t stop it from being true, though. And it didn’t stop it from being a reality that so many other people are facing, too.

I was in the US at the time, on the Mandela Washington Fellowship. Far from “home”, far from my support structure. I felt very alone, because I was also the only queer woman in my cohort. And there I was in the Republic of Junkfood and Unhealthy Eating.

Before I left for the US, I was in pretty good shape. My week of self-harm and starvation left me in the best shape of my life. I’d been working out, too. My body image wasn’t in a great place, but I’d at least managed to rebuild it somewhat.

I didn’t want to let go of that. Frankly, I was terrified of what might happen if I did. If I “let myself go” (another hated phrase), and my body image was compromised… well, I might land up in another cycle of dysphoria/despair/self-loathing. And I was worried it might be worse than the last one, given the circumstances. By that time, I’d started to understand that it could even be life-threatening.

I started working out. Running. A lot.

I started tracking what I was eating. Meticulously.

I became scared of eating. Because if I ate the wrong things, or I ate the wrong quantities, I felt it. And it was visceral. I felt disgusting, bloated, revolting, hideous. Eating made me upset with myself. The thought of eating made me upset with myself.

I started skipping the group meals that were organised for us, or the catered dinners. My rationale? “If I can’t track it, I can’t eat it”. I needed to have certainty that I was in control at all times. It was the best way for me to handle the anxiety, at the time.

And it worked. I stayed in shape, if nothing else. And constantly obsessing over what I did or didn’t eat was a small price to pay.

I kept on running. Further, faster, longer. Especially when I got back to South Africa. Exercise had become a coping strategy. And it also became a stimulus for trying to eat correctly – because I didn’t want to risk getting injured. Great motivation, isn’t it?

By the time I returned, I was already vegetarian. Before long, I was vegan. The details around that I’ll discuss another time, but not eating other sentient beings helped me to feel less revolted at the act of eating, amongst other things.

Between my preoccupation with exercise, and my predilection and passion for cooking, I managed to do a reasonably good impersonation of a functional human being for a while. I ate relatively healthily, logged everything, worked out a lot – it was all on track, at least on the surface.

The fact of the matter is that underneath that glamour, I was still obsessing over every decision I made with regards to food.
“How many calories are in this?”
“How will I feel if I choose to eat this?”
“Can I go without it?”
“Have I exercised enough to pay for this?”

My calorie target, because I’m still just-too-goddamned-fat, is 1200/day, in the absence of exercise. And I don’t go a day without at least 500 calories worth of exercise. Some days, 1400 or more.

There’s been the odd day where I’ve overshot my target and felt guilty. Now, let me give you some context – 1200 is not a lot of calories. On average, an adult needs 2000 calories to maintain their current weight. 1200/day correlates with a pretty strenuous weight-loss program. In fact, even if you overshoot your goal by 500 calories, theoretically you should still lose weight – just not as quickly.

The idea of systematically tracking everything I ate always felt creepy to me. It was something I never wanted to do. Because I figured that having that degree of obsession was unhealthy. It wasn’t a decision I took lightly; I only reached it once I’d got to the point where I recognised that the way I was living was already unhealthy. So this couldn’t possibly make it worse. And if it gave me some degree of control, or helped me to reach an endpoint where I was more functional, even if the underlying thought processes were still distorted, well then maybe that wasn’t such a bad thing after all.

It’s funny, but I think I almost managed to fool myself that I had it all under control, for a while. During all of this – the training, the cooking, the tracked eating, the changes to my diet – I was still aware that there were sharks lurking beneath the surface. But I was functional, and that was good enough. The numbers added up, mostly. I knew the wheels could come off, but as long as they didn’t, then it didn’t really matter.

You can guess, I’m sure, what happened next.

The interaction between an eating disorder, gender dysphoria, habitually worn-down self-esteem, and a tendency to self-harm, inter alia, is complex, to say the least. Sometimes, most times even, I can’t pick apart where one aspect ends and another begins.

Intellectually, I have known for a long time that none of this stuff ever just goes away. Not completely. Like the dysphoria, for example. I’m in a much better place than I was two years ago, but it still has the capacity to rear up out of nowhere and bite me in the ass.

And the eating disorder is the same. I have to figure out how to manage it in a way that works best for me. There’s no right or wrong. And there sure isn’t a cure. And for all the effort and the coping, there may still be times that my ass gets bitten. All it takes is one bad day. And sometimes, the reason isn’t even apparent – it just kind of happens.

For someone who is often very data driven and logical, that can be a bitter pill to swallow.

In any case, my most recent one bad day happened shortly before I sat down to pen this post. I woke up tearful and feeling a little hopeless. I tried to sweat those feelings out at gym, which often works for me. But nearly two hours of hard training later, and I was still a mess. Couldn’t bring myself to even think about eating. Before I knew it, my thigh was bandaged up again. I ended the day with a sum total of 41 calories (again, a cappuccino. Almond milk, of course). And a deficit of >2000.

The next day I managed a deficit of 1000. I went for an early, hard run and downed some recovery mix and a protein bar before I had a chance to properly even think about it. Ate a dinner of vegetables and tofu, no carbs. Went the day without cutting.

Day 3 and eating still difficult. 162 calories, from coffee. 2 hours of exercise. A few more cuts.

Some days are better. Some days are worse.

And this is how it goes, I suppose. The truth is that I’m still learning; I don’t understand this, any of this. I’m trying to figure it out, and I’m trying to figure me out. So much of all this just blatantly contravenes things and ideas that we take for granted. Like that you’re not supposed to want to take a blade to your own skin. That you’re not supposed to be revolted by the thought of food, even at the brink of exhaustion.

I think there’s a fascinating irony, to recognise that self-harm can be a survival mechanism. Seems paradoxical, but it’s true. I’ve experienced it – and continue to experience it – myself.

Anyway, there’s my confession, out in the open and no punches pulled.

I’m fighting as hard as I can find the will to, and doing the best that I can. And if you’re in the same, or a similar boat, then I hope that, if nothing else, this has affirmed for you that you’re not alone.