A Midlife Cyclist

by Rachel Ann Cullen

  When I’m forced to eventually leave the sanctity of my window, and I haven’t been able to rectify the visible damage I have done to myself, then panic sets in. How can I leave the house? What will people think when they see me? How can I possibly face the seminar group, today? Will I recognise the look of disgust in their eyes when they see what I have done to myself? Will ugliness accompany me everywhere? Is this my constant companion, now?

  It feels as though I have succumbed to this being my life, and I have accepted that this is how I will now fill my days. I find it increasingly difficult to concentrate on anything at all, from my Law degree to the social goings-on which I am no longer a part of. This thing that has engulfed me has robbed me of it all, and I no longer have the energy to fight back.

  The skin-picking is getting worse, and there are many times when my face, my neck and my fingers throb with pain. I can feel my body trying to heal itself, desperately forming scabs where I have hurt it. But then I go and do it all over again and tear at the sores, simply unable to accept that I now have ugly scabs on my face. My only response is to try and rip them from my body, and to fight the onset of ugliness which has hunted me down and now has me trapped.

  I can’t see a way out.

  * * *

  THURSDAY, 9TH FEBRUARY 2017

  I’m heading to the gym to try again with my new best friend, the static bike. Reluctantly, I complete three sets of my recently discovered indoor cycling interval sessions, and miraculously, I manage once again not to fall off the slippery seat.

  I follow this by shoehorning myself onto the one remaining exercise mat, in between a man who is attempting abdominal crunches using some plastic rocking contraption from the 1990s and a woman who looks worryingly uncomfortable on a stability ball. The old guy smiles at me and says, ‘Any excuse for a rest, eh?’ as I sit myself down on the mat next to him, desperately wishing I were running instead of this.

  Funny bastard.

  In frustrated silence I complete my futile rehabilitation exercises, and then it’s on to my yoga class. I feel fat and heavy as my Bastard Chimp is having a field day without running to ‘manage my weight’. This is the ridiculous, bullshit mantra I’ve been telling myself for the past fifteen years: YOU NEED TO RUN TO NOT BE FAT, RACH. WITHOUT IT, YOU’RE THAT SEVENTEEN-YEAR-OLD MARS BAR-MELTING LOSER AGAIN … I can’t believe how quick my Bastard Chimp is to jump onto this cruel and painful bandwagon after such an offensively short time without running. It makes me sad to think that these thoughts have never really gone away. I thought they had, but it looks like I was wrong. Being unable to run even for this embarrassingly short period of time has brought to the fore a whole raft of mental health issues that perhaps – and please excuse the awful pun – I have been running away from. Is that the truth? Maybe running has simply been a sticking plaster over the deep-rooted, soul-haunting glitches I know about myself that I don’t honestly want to tackle. That possibility was made abundantly clear this morning, when an innocent comment by a six-year-old girl sent me into a headspin of epic proportions.

  In preparation for my eagerly anticipated ONE MILE test run, I rush downstairs half-dressed. I’m still wearing my slightly questionable gingham pyjama top, but I’ve changed into Lycra running tights. Admittedly, it’s a strange combination. When I take off my pyjama top to replace it with a thermal running layer, the innocent six-year-old points to me and says, ‘HA HA! You’ve got a FAT TUMMY!’

  Time stops. I stand completely still, and I’m rendered motionless in my stunned state. I can feel my head beginning to pound. It’s melting into a confused, emotional rage that I couldn’t possibly have foreseen. I fly upstairs, shut myself in the bathroom and weep uncontrollably, as my Other Half tries to reassure me quietly through the locked door that his six-year-old daughter would call a broom handle ‘fat’ given the opportunity (she has three selective adjectives, the other two being ‘stinky’ and ‘poopy’ – either of which would have been preferable to ‘fat’ for my irrational brain).

  With tears still stinging my eyes and streaming down my cheeks, I head out of the front door for my one-mile test run. I feel like Fred Flintstone’s car: barely moving forwards on clunky, semi-spherical, Stone Age wheels. My emotionally drained state doesn’t help matters, but I reach the end of my ridiculously condescending single mile of slow, downward trudge and berate every second of it. My legs feel heavy and cumbersome – and they hurt. I don’t ‘ease’ into it, and the tightness never loosens its grip – not one bit. It feels like I’m running on two wooden legs that are not – and never were – meant to be mine. WHERE HAVE MY LEGS GONE? I WANT THEM BACK!

  Heartbroken and deflated, I slump into the passenger seat of the car as my family picks me up just a single mile away from our house. The girls are subdued in the back. I can feel that they are cautious of me, and they feel unsure how I will respond. Maybe they are wondering if I will explode/break down into inexplicable tears again. Is she going to have another meltdown? I can imagine their six-year-old minds contemplating, weighing up the risk of a repeat performance from earlier. Is she calm again, now? I can see their young eyes questioning.

  I feel sad: I wish I knew the answers. And I wish I knew how to protect them from these thoughts and feelings – my ugly companion for the last twenty years.

  We drive home in silence, where I try my best to move on from the ‘Fat Tummy’ incident, which continues to taunt me. My young daughter doesn’t need to live my angst, and she shouldn’t have to even try to understand why I have a meltdown over an otherwise innocuous, silly comment. Unfortunately, on this occasion, I couldn’t protect her as I would have liked. Normally, my running helps me to do that.

  5

  HELP!

  ‘Your tummy looks fat in that … Your tummy looks fat in that … Your tummy looks fat in that … Your tummy looks fat in that …’

  The words of a six-year-old little girl play on constant repeat in my head. They ring in my ears and echo all around me as though I’m trapped in the longest, darkest tunnel. I can’t switch it off, and I don’t know how to mute the sound, but that’s just the tip of the iceberg. I know what’s been happening to me lately, and it’s far bigger and scarier than this one tiny, isolated incident, which doesn’t in any way qualify me as suffering from body dysmorphia. Not at all.

  Feeling ‘a bit fat’ doesn’t come anywhere close to experiencing the full horror of the condition that I know so well, and fear so much. It’s like being haunted by a ghost which has never gone away. And since my running has abandoned me, I can see the ghost more clearly and more frequently. I can feel him breathing down the back of my neck, and whispering things into my ear. Cruel things. He’s becoming stronger and louder, bolder and more convincing than ever. And the realisation of this fact is one of the most frightening things for me to face.

  I have been forced to recognise that body dysmorphia has been my silent companion for the past twenty years. According to the charity, The BDD Foundation, body dysmorphic disorder (or ‘BDD’), describes a debilitating preoccupation with perceived defects or flaws in a person’s appearance. It can affect both men and women, and makes sufferers excessively self-conscious. They tend to check their appearance repeatedly and try to camouflage or alter the defects they see, often undergoing needless cosmetic treatments. Onlookers are frequently perplexed, because they can see nothing out of the ordinary, but BDD causes devastating distress and interferes substantially with the ability to function socially.

  This has been my reality, and over the years, it has ebbed and flowed. At times, BDD has crippled me completely to the extent that I have struggled to leave the house. Perhaps the worst episode was during the late 90s whilst I studied for a Law degree at the University of Hull. My weight plummeted, leaving me with sagging, asymmetrical breasts. And although that was thankfully soon rectified by breast reduction surgery, I believe it was the trigger for a far greater problem: one where all I could see about myself were flaws.

  During ‘the Proz
ac years’ of my twenties, the symptoms of BDD abated to the point where I was no longer crippled with the condition. I was always acutely aware of my physical imperfections and misgivings, but no longer a prisoner in my own home. In retrospect, it’s my belief that being prescribed Prozac for my other mental health issue – bipolar disorder helped me to manage the condition with some success, rather like a happy coincidence. SSRI medication (of which Prozac is one type) is widely regarded as being one of the most successful treatments for BDD, and in managing the crippling symptoms.

  I haven’t been taking Prozac medication for some eight years, and I am the Queen of Denial. Look how successful I’ve been in denying my body doesn’t want to run! Being particularly gifted in this way has helped me to ignore all the flashing neon warning signs that this ghost is coming back to haunt me but I can’t run away from it forever.

  I am standing facing the large mirror which hangs proudly over the fireplace in our living room. I’ve been here for a good while now, running my wide-toothed comb through my long hair and going over the same small sections with my hair straighteners. It was poker-straight a good while ago, but I go over and over it again, just in case. It now feels like I’m ironing straw rather than hair, and I’m frustrated because of all the static I’m creating, but holding out for perfection.

  ‘Do I look OK, Tills? Does my hair look OK?’

  My daughter is playing with her Sylvanian Families camper van at my feet, and my tiresome questions are interrupting the pizza delivery which Mr Hedgehog is about to make to the Rabbit family on his moped. The words come out of my mouth and I immediately wish that I could stuff them back in and swallow them, pushing them deep down into the pit of my stomach. I feel ashamed that this compulsive questioning is simply too powerful for me to resist.

  ‘Yes, Mum, it is. Why do you keep asking me that?’

  ‘Sorry, Tills. I – erm – I’m sorry.’ There’s a brief silence filled only with my shame. I hate myself once again for allowing the words to spill out, but it’s too late now. Seconds pass, and it happens again.

  ‘But are you sure? It’s just that I’m wondering if the hairdresser has got my hair colour right, this time. Is it too dark? Do you think the colour is too dark?’

  ‘MUM! STOP! I won’t answer you if you ask me that again.’

  She is simply tired of my futile, pointless questions, and her instinct is absolutely right: she knows that she is not helping me in any way by responding to my desperate need for constant reassurance. And it’s been happening a lot more recently.

  I finally switch off my now seriously overworked hair straighteners and give myself one last glance in the mirror. And then another … but I’m not altogether sure what I’m looking at any more, just the outline of a person in a frame. I trudge through to the kitchen, where my Other Half looks up from the table and gives me a pitiful look. He has heard me quizzing Tilly about the shade/colour/cut/straightness/static of my hair, and he doesn’t need to say anything at all; it’s written all over his face. As I shuffle around the kitchen unpacking the dishwasher in silence, and pointlessly rearranging mugs in a cupboard, I desperately want to ask him if my hair looks all right, but I manage to hold it in as though I’m stifling a sneezing fit. I’m not thinking about my shame any more. It’s like being Dory the fish. Because, other than Dory, when does anyone ask the same question, to the same person, within moments of receiving an answer?

  When they’re in the vice-like grip of body dysmorphia. That’s when.

  Later that evening, once Mini Me is tucked up under her pink unicorn duvet, my Other Half broaches the subject. ‘You need to stop asking Tilly how you look, Rach,’ he says kindly, offering me his open bag of Revels to ease the blow (I always end up with the coffee ones). ‘It will damage her. You have to find a way to stop it.’

  My first instinct is to cry, run upstairs and throw a huge tantrum, because I DO NOT WANT – OR NEED – TO BE TOLD THAT I AM POTENTIALLY ‘DAMAGING MY DAUGHTER’. I’m a good mum … I’m the best mum I can possibly be … I have spent the past seven years bringing my daughter up to believe that she can do anything! All kinds of things. Take junior parkrun, for example. I have taught her that she can be brave enough to stand on the start line, and try her very best to make it to the finish.

  Instead, I sit and squirm on the sofa, forcing myself to stay there and not dart upstairs like a stroppy teenager who’s just been grounded. Because I know that he is right. This ghost has come back to haunt me, and I need to exorcise him once and for all – if not for myself, then for my daughter. So, I won’t run away from this conversation, I will sit and listen, as hard as that is. You see, I’ve known this monster has been growing in strength and ferocity since my loss of running, and although it may have been lying dormant for some time, it never really went away.

  I’ve been aware that the condition ‘body dysmorphia’ exists for a long time now, but there wasn’t an epiphany as such. There was no ‘A-ha!’ moment, no single point in time when everything miraculously made sense to me: when I suddenly saw my self-loathing and perfection-seeking as anything other than just unfortunate ‘quirks’ in my wiring – just a part of who I am. It took me a long while to join up the dots. I would read magazines and books, and watch TV. Problem pages, talk shows, ‘real life stories’. This drip-feed of awareness happened over a long period of time, far longer than I can even recall. Eventually the penny dropped.

  I sit on my bed, google searching ‘BODY DYSMORPHIA TREATMENT’, because I know that I can’t deal with this by myself. As I scroll through page after page of information, I focus on one particular search: getting help with BDD.

  I read all about the two main treatments offered for the condition: Cognitive Behavioural Therapy (CBT) and/or medication – usually in the form of SSRI antidepressants, which I know so intimately already. In amongst all the information, support and advice I read about online, I come across a website advising of a research study being undertaken by a psychologist at the Karolinska Institutet, Sweden’s largest centre of medical academic research. This study is designed to establish the feasibility of successfully treating BDD using Cognitive Behavioural Therapy via an online treatment model. YES, THIS IS IT! THIS IS WHAT I NEED! Soon, I find myself fully absorbed in the process of filling out endless extensive psychological evaluation and assessment questionnaires. I’m trying to be as brutally honest as I can possibly be, because I so desperately want to be accepted onto this treatment programme. It feels like I’m being thrown a lifeline. An hour or so later, I click ‘SUBMIT’, knowing I’ve done all I can.

  Two days later, I receive an email:

  Thank you so much for expressing interest in being a participant in our research study at Karolinska Institute. We will contact you shortly about scheduling a time for the next stage of the screening process.

  YES, YES, YESSS!!!! It feels like I’m inching ever closer to receiving some help. I’m desperate to avoid making the return visit to my GP and have him prescribe my old friend Fluoxetine (Prozac) after this long period of abstinence. Of course, if there was absolutely no way of taming this beast without taking Prozac, then sure – I’d consider going back onto medication – but I really want to look at all other options available to me, first.

  I do some more research on Cognitive Behavioural Therapy:

  ‘CBT is based on a structured programme of self-help so that a person can learn to change the way they think and act’.

  Hmm … I like the sound of that.

  ‘CBT starts with building a good understanding of the problem and what is keeping it going in terms of how your mind works. One way of thinking about BDD is that it is a problem of “not being able to see the wood for the trees” – that you can no longer make an objective assessment of your appearance because you have become so distressed and preoccupied.’

  Yep. That’s me.

  ‘During therapy, you are likely to learn to re-focus your attention away from yourself and re-engage with activities that will improv
e your mood and your life.’

  YES, I WANT THAT!

  ‘To fight back against BDD, you will be asked to resist comparing your appearance, to stop ruminating, test out your fears without camouflage and to stop rituals such as mirror-checking and excessive grooming.’

  Oh shit! That sounds scary. No more asking a million times a day if my hair looks OK? Gulp.

  ‘Many people find it helpful to think of CBT for BDD as training in how to stop being bullied by their BDD and to re-direct themselves into all the other aspects of living that are important to them.’

  GOOD! I need to tame this beast once and for all.

  ‘The main side effects of the treatment are the feelings of increased anxiety that occur in the short term. However, challenging one’s fears becomes easier, and the anxiety gradually subsides.’

  I simply have no option other than to believe that it does.

  Some days later, I receive another email from the research programme’s Project Manager, Dr G. He invites me to undertake a comprehensive video assessment interview so that he can establish my suitability for the research programme and for the CBT treatment. I have never been formally diagnosed as having body dysmorphia before, having only been treated for bipolar disorder, but ever since I discovered such a condition exists, I knew instantly that I have lived with BDD for a very long time.