“We either make ourselves miserable or we make ourselves strong. The amount of work is the same.”
This morning, more than six hours ago, I drank half a cup of white tea. Now, I am so bloated that no position I can contort myself into—cross-legged in my office chair, supine on the dirty staff room couch, slumped over my computer, pressing on the hardened balloon of my abdomen—relieves the pressure.
Caffeine, in any form, is one of the biggest triggers for my gastrointestinal disorder, irritable bowel syndrome. I shouldn’t have had that white tea, but I’ve already experimented with replacing espresso with half-decaf, half-decaf with black tea, and now black tea with white. I’m a hardworking professional with three jobs, and I should be able to imbibe some caffeine when I need it.
Frankly, I think my stomach should reward me with a free pass. “You’ve really been disciplined these past few weeks,” it might congratulate, like an enthusiastic coach. “Take a break. Eat some Brie. Drink a latte. Enjoy yourself.”
Perhaps a leftover of the eating disorder I struggled with for decades, I mistrust my body. I worry that the childhood sexual abuse I suffered made a holy mess of my body’s control center, causing it to go rogue. There is substantial research indicating that women have a higher likelihood of developing IBS, and a study from 2001 claimed that 50-90 percent of IBS sufferers have co-occurring mental disorders. A 2017 study replicated these results.
IBS is a disorder of functional, not structural, changes. The illness is unable to be ascertained by colonoscopy; it is a diagnosis of exclusion.
Despite the research, I sometimes still believe my body is out to get me. Perhaps as a side effect of this, I personify body parts in order to have someone or something to blame. I regard my stomach and intestines as nuisances in my life—like misplacing all my ChapStick at the same time or co-workers who use reply-all—rather than parts of me that need extra care. Through this personification my stomach has taken on the character of my 89-year-old grandpa, a perpetually disgruntled Ukrainian man who seems to believe that sharing his constipation woes makes for dynamic conversation. Stubborn and abrasive, he excels at the Jewish guilt my family is known for.
“Oy,” my grandpa/stomach voice will mutter, as I impulsively order broccoli-cheddar soup with the full, cognizant knowledge that both dairy and broccoli are trigger foods. The small bowl of Panera goodness in front of me is about to set my intestines aflame. “Why must you do these things to me?”
Part of the problem is that my intestines are lazy. IBS is a disorder of functional, not structural, changes. The illness is unable to be ascertained by colonoscopy; it is a diagnosis of exclusion. When I eat a food that agitates my intestines, they refuse to continue their job of peristalsis (the mechanical function whereby food and gas are pushed towards the colon.) The mass inside of them builds up until I look like I’m entering my third trimester.
“Eh,” my grandpa/stomach says, “you knew what you were getting into.” Grandpa/stomach will sigh deeply while reviewing restaurant menus and picking over buffets, where everything has been topped with cheese or onions. He is the voice of annoyed reason that compelled me to finally make, and reference, a list of foods that are not safe for me to consume.
If I can’t eat or drink my feelings after work, what else is there?
Many of these food items are taken from the FODMAP diet recommendations. FODMAP stands for fermentable oligo-, di-, monosaccharides and polyols. These are all carbohydrates resistant to digestion, especially in people like me with preexisting gastrointestinal disorders. Food items you might think would be completely innocuous and without carbohydrates—plain greek yogurt, onions, almonds, avocado, soy milk, and sugar-free gum—are major trigger foods. FODMAPs exist in especially high amounts in gas-producing foods, like beans, broccoli, Brussels sprouts, and cauliflower.
Avoiding trigger foods is really hard, but it’s not the thing holding me back from recovery; that thorn in my side is entitlement. Entitlement for what I believe I should be able to do as a free-thinking adult. It is the rejection of my illness in favor of the denial that keeps me sick.
I am a psychiatric professional who spends six days a week with the chronically mentally ill. I treat victims of sex trafficking, refugees who have lived through genocide, actual murderers, and a pedophile here and there. If I can’t eat or drink my feelings after work, what else is there? If my continued good health and comfort depends on me ditching chocolate, alcohol, mozzarella cheese sticks, milkshakes, the most amazing fried cauliflower dish at the best Indian restaurant in town, onion and garlic, most all Italian food, or a 7,000-calorie Starbucks latte around the holidays, what can I do to reward myself?
Every morning, I eat the same breakfast: a gluten-free plain bagel with tofu cream cheese and cucumbers. Lunch is a salad with “safe” toppings, like sweet potato and bell peppers, and dinner is whatever frozen thing I can find in my freezer that cooperates with my dietary limitations. Some days, I am too sick to eat and must decide which I prefer to experience: the hollow pain of hunger or the bloated pain of IBS.
Real talk: My gas, after eating a no-no food, is epic. Farts seize to be funny when you are worried you will have to interrupt a therapy session to run out of the room and rip one or that your co-workers think you are using cocaine because you go to the bathroom so often. Being gassy, however, is actually a best-case scenario for IBS; when the bloat is bad and my intestines have narrowed, nothing will come out for days. I have to wear special stretch pants to work because I don’t fit into anything else.
I spend every day trying to accept that IBS is an illness and not a punishment from my body. In my post-eating-disorder life, I am trying to develop respect and show compassion toward my body and that requires first developing trust. I need to trust that my body does not have malignant intentions for me, and my body needs to trust that I am not going to binge on free birthday cake just because it’s there.
Illness often gives new definition to the concept of health.
Finding joy in activities that do not revolve around food is an ongoing process, because I really love to eat—but I think it is another way I can show respect toward my body. Exercise, making artwork, and listening to the smooth narrations of David Attenborough bring me joy and reduce my stress level, which ultimately improves the symptoms of IBS. Decades of therapy, and the five psychiatric medications I take per day help too.
The truth is, sometimes, eating a Reese’s Peanut Butter Cup is “healthier” for me than eating a plate of roasted asparagus. That candy isn’t going to make me miserable in the long run, and though it is not nutritionally beneficial or a meal replacement, it is a safe food I can easily purchase at a bodega in a pinch. Illness often gives new definition to the concept of health.
Entitlement tells me that if I follow the ubiquitous mantra of “no pain, no gain,” I will triumph over my disorder. Real life and experience has shown me there may be some pain for some gain—or there may be a lot of pain for no gain. My body is not a computer I can type commands into. It’s a complex, constantly changing system with glitches I cannot repair, no matter how insistent my demands.
Carlos Castaneda says that the energy expenditures of misery and strength are equal, and I wholeheartedly agree. Denying my illness and staying sick is just as exhausting as making the lifestyle changes that are going to improve my overall health. It’s the long game I’m playing, and my mantra, the very same one I tell patients struggling with their own recovery, no matter from what, is this: Progress, not perfection.