A day in the life of an Agoraphobic/Anorexic Nervosa sufferer

Far away there in the sunshine are my highest aspirations. I may not reach them, but I can look up and see their beauty, believe in them, and try to follow where they lead.
Louisa May Alcott


My sister Lynda had a number of mental health conditions which very much like mine often become entwined one with another. Lynda had most of her main conditions clearly diagnosed and these where, Agoraphobia and later Agoraphobia with panic disorder, depression and eventually anorexia nervosa. I classify these four as the principal conditions mainly because all four where of significant detriment. However from the aspect of which coursed the most problems in my sister’s life it is difficult for me to ascertain. Most certainly all where incapacitating, anxiety provoking and prevented my sister from living a full life. However anorexia nervosa may be considered by a mental health expert to be the most detrimental and therefore the primary condition from the view point that it had the potential to be life threatening. Lynda was also prone to general anxiety with episodes of free floating anxiety which may have qualified her for a diagnosis of General anxiety disorder GAD. She also had Hypochondria, dentist phobia, social anxieties, and anxieties about hospital treatment presented throughout her life, whether or not these where formally diagnosed is unclear. However Lynda suffered from all of the aforementioned conditions.

My sister was like myself was very shy and my well have been considered for a diagnosis of either social phobia or Asperger syndrome had of course the later diagnosis been available when she was younger. Suffice it to say Lynda was very shy, awkward in social situations, often outspoken tending to say what she thought, rather like myself she rarely fitted in social situations which with few exceptions where an ordeal. To my knowledge her social anxiety was never diagnosed or addressed, which is unfortunate because also like me her inability to interact socially impeded her treatment often to the point where opportunities for therapy where turned down, Lynda often being unable to cope even with the social aspect of keeping an appointment to see a therapist. Which of these conditions was of the most detriment is impossible to say and indeed it serves no purpose to do so as of course all conditions interact with each other and effect one another. In her later life she became much more detrimentally effected by her mental health problems. In her late teens Agoraphobia presented first and it was not until more than a decade or so passed that Lynda developed anorexia nervosa and you can read her story here: Lynda’s Story The other conditions had been present right from early childhood to some degree or other, in particular social anxiety and hypochondria.

However regardless of the details, all of these conditions affected my sister’s life, which was very complicated due to the interaction between these conditions, none of which should ever be considered in isolation or ignored, or considered as not important or part of anyone’s personality.

The following account represents a typical day in Lynda’s life towards the end of her life. At this time after receiving therapy, which I believe included an antidepressant, Nardil and desensitisation therapy, Lynda was coping with her agoraphobia and panic disorder, however these conditions still nevertheless presented a problem. There was no cure, she had simply struggled to cope with the symptoms, the anxieties continued however to present as they had done for most of her adult life. At this time Lynda struggled with her shyness in much the same way she had learned to cope with her agoraphobia, however unlike her agoraphobia there had never been any intervention, any help as far as I am aware, nor any encouragement she had simply tried to overcome her social hang-ups in order to live some kind of normal life. it appears that her social anxiety was completely ignored regarding any formal therapy

In the last few years before her death she had made good progress and had been part of a group of fellow mental health sufferers who met and took part in a variety of activities at a centre for the mentally ill. Here Lynda had made a friend or two and had been encouraged to take part in adult education classes as a result of a patchwork class that she had been involved with at the centre. Feeling successful and interested in the craft of patchwork Lynda had decided to take it further and acquire a qualification which would stand her in good stead as a professional designer of patchwork such as quilts, cushions and the like. Although she knew that she would never be well enough to earn a living from this Lynda was keen nonetheless to learn and to improve this skill solely for the pleasure of learning. There would be many obstacles of course, perfectionism and lack of self esteem added to the toll along with her constant battle with agoraphobia, social and general anxiety.

At this time Lynda continued to suffer with anorexia nervosa it had only been a couple of years since she had successful completed therapy at a day hospital for people with eating disorders . This had been a struggle for unlike other disorders of a similar obsessive compulsive nature such as OCD the sufferer of anorexia gets some satisfaction from the obsession. A thin figure brings with it a sense of achievement, the feeling of accomplishment and because of this it is more difficult to overcome unlike OCD where there is no satisfaction derived from the misery of complying with endless compulsions. While the sufferer of OCD is desperate to rid herself of her OCD the anorexic however clings to her obsessions because she derives some perceived benefit however neurotic it appears to others. The sufferer of anorexia finds the inner conflict difficult to contend with.

To add some interest I have included a selection of quotations here and there throughout this account.

A day in the life of Lynda a sufferer of agoraphobia and anorexia nervosa

This account it is based upon the weekly conversations my sister Lynda and I had over the telephone where we discussed our respective difficulties concerning the trying lives that we both lead. The article below focuses upon a typical day in the life of my sister. It includes flashbacks to other occurrences in her life which reflect the problems my sister faced throughout her difficult life. The account is by no means comprehensive but does give a glimpse, an inking of what it is like to suffer with multiple disorders.

Security is mostly a superstition. It does not exist in nature, nor do the children of human kind as a whole experience it. Avoiding danger is no safer in the long run than outright exposure. Life is either a daring adventure, or it is nothing at all.
Helen Keller

Lynda awoke early most mornings, early than most people. She had done so now for many years partly due to the habit of rising early for a job she once had cleaning a school building, a job she had had to quit because of her battle with agoraphobia which although she had now under better control nonetheless was a struggle from time to time, a struggle that on occasion she did not always win. Most days Lynda woke with feelings of anxiety, they presented before she was barely awake hardly aware of the familiar surroundings that did little to improve the situation and were in fact remembers as soon as she opened her eyes of so many similar mornings when she woke feeling so anxious for reasons she could not quite understand.

As soon as she opened her eyes she was alert, anxious listening to every sound. Since moving to the new apartment she had been less apprehensive concerning noise. In their previous residence she and her husband of thirty four years Mike now retired had been compelled to leave because of the noise of a neighbour in a downstairs apartment who played loud music throughout the night. Also but to a lesser degree another neighbour had had the radio on the entire day, Lynda could not bear the continual drone. It had not only been the noise but it was the intrusion, an infringement, as though her home was trespassed by noise, invaded. She had no option except to have her own music to mask the noise which she turned on the minute she had woken in order not to hear the inevitable drone of this neighbour’s radio which continued unabated throughout the entire day. Whenever Lynda left the house she kept her raid on, she could not bear to hear the disturbance of her neighbour’s radio the minute she returned. It had not been the neighbours fault, she understood this, these apartments where not soundproofed, any noise of any volume would be heard in neighbouring flats. So in this instance there was no grounds for complaint unlike the problem during the night which seemed never to be resolved after calling out the council health and environment department. Often it took months before such situations where resolved if in fact they were ever satisfactory put right. Lynda was extremely sensitive to sounds often hearing sounds which others appeared not to hear or if the did they seemed not to be bothered by them. In the finish the only solution had been to apply to the council for a transfer.

Lynda’s husband Mike sixteen years her senior was eligible for an elderly person’s sheltered accommodation. Although Lynda considerable younger felt rather awkward living in such a situation she had in many ways felt more relaxed safer and more comfortable than anywhere else. There had only been the one apartment available for immediate occupancy. It was not ideal being considerably smaller than their present accommodation and the bedroom was an awkward shape , it had been rejected because of this by many other potential tenants. However Lynda had been keen to accept virtually anything to get away from the nightmare of noise, she did not feel as though she could cope any longer. A life of continuous anxiety had made her increasingly more sensitive to any difficulties in her life and the council allocating a young man to the bottom apartment had been the last straw. In addition to music from a stereo he had played his drums in the early hours of the morning.

Anxiety is a thin stream of fear trickling through the mind. If encouraged, it cuts a channel into which all other thoughts are drained.
Robert Albert Bloch

In spite of her improved environmental circumstances Lynda continued to wake with these dreadful feelings of anxiety has she had done throughout her entire life. They were perhaps habitual as though a circuit had set itself up her brain to react this way. The medical term for this non-specific morning anxiety was free floating anxiety. It was a nameless indefinable anxiety and it came without a recognisable cause. Lynda of course was familiar with anxiety though, no matter its associations or otherwise, with or without a perceivable reason it was pretty much the same awful sensation. It was there whenever she left her home, it was present whenever she had to associate with someone; whenever the phone rang her heart would leap to her mouth and pound in her chest, she never answered the phone leaving this task to Mike. Anxiety presented each dinnertime whenever she put any food to her mouth, fearful of putting on weight it was as though her flesh grew with each bite that she took. Moreover it was not only fear of being fat but fear of loosing the only thing that she felt that she could control, the only thing in her life she felt she had succeeded at. She felt perhaps others envied her, she had after all done something few others could ever do, yet at times she envied others always anxious someone was slimmer. She immediately felt competitive with anyone loosing weight, she became anxious when her sister began to loose weight when she too was on the verge of anorexia. One Christmas whilst visiting her sister and her family Lynda had sat done to cottage cheese and salad for Christmas dinner her sister had gone to bed with migraine and was being dreadfully sick. To Lynda’s mindset it was as though there was a competition, her sister was not eating today and consequently getting thinner and Lynda had felt even more anxious not to overeat even on this festive occasion.

An all pervasive consuming fear yes indeed there was no hesitation here to use the word fear concerning the effect these conditions had upon her life. The sensation when she left the house was nothing less than fear, an utter dread. Her heart would pound in her chest, her legs turn to jelly, pervasive fear coursed through her body rising to a lump in her throat. At times the fear was incapacitating as though she could not move. She did not know why, for she had never had a frightening experience that she could relate to which precipitated these feelings, they simply came much like the feelings one gets when one is ill. When she was younger these feelings had been so powerful that even standing on her own front door step she had been paralysed by such dread, it was as though there had been an invisible barrier preventing her from leaving her home and she simply could not get past this obstacle for the feelings where just too overwhelming. Often she would cry and shake with anxiety. As the years passed agoraphobia was joined by panic disorder an extreme sudden inexplicable anxiety attack which like free floating anxiety appeared not to be precipitated by any perceivable cause. These attacks occurred right out of the blue suddenly without warning. When it had first happened she was afraid she would die and was having a heart attack, the fear was so overwhelming.

Every act of life, from the morning toothbrush to the friend at dinner, became an effort. I hated the night when I couldn’t sleep and I hated the day because it went toward night.
F. Scott Fitzgerald

Most mornings Lynda felt the familiar feelings of anxiety enhanced by the burden of depression. Life was a struggle she and her husband where not very well off. Before retirement Mike worked for a low wage with a charity for the elderly; Lynda unable to work due to her disorders. Yes indeed life was difficult and everyday presented a challenge. What would appear to be routine and mundane and of little consequence to most people was a mammoth problem for Lynda. Struggling to get out of bed the agony of getting ready presented itself. Because of low self esteem Lynda was anxious about her appearance. She often found herself peering into the mirror studying her face ruminating on this or that feature which gave her concern. Aging had increased this preoccupation but throughout her life she had hated the way she looked and despite being attractive she had never been satisfied with her appearance and this had added to her feelings of inadequacy and social interaction problems. Teasing at school becasue of her almond shaped eyes had done much to undermine Lynda’s self confidence despite reassurances from her mother that this as she grew older would be an asset, an enhancement to her appearance.

Today would be a busy day for Lynda there was an appointment at the optician and a class for her City and Guilds course and there was the ladies sewing circle in the late afternoon. Yes amazing even herself she had got together a small number of the other residents to teach them the skills of patchwork. It was indeed an achievement but was anxiety provoking nonetheless. With one or two exceptions Lynda seemed to associate with her fellow residents better than she had done in other situations with groups of people. Perhaps it was because most of the residents where much older and she felt safer, she was not sure why but here in her new apartment she was more secure than she had ever been in her life. Even Madge the rather spiteful resident who complained that the communal room was not meant for a sewing room had not deterred Lynda although this of course this incident had produced anxieties.

Lynda was always particular about her breakfast, one Weetabix and a tiny drop of milk. Yes Lynda had gone back to her rather obsessive eating habits despite recently undergoing therapy for anorexia nervosa at a day hospital. The whole thing had been an absolute nightmare, not only the therapeutic method for her anorexia but also her social anxiety made this an increased ordeal. Most of the other patients where many years younger this made social interaction even more difficult. It was at the time of treatment considered very unusual for a person of Lynda’s age to be anorexic although Lynda had had eating problems most of her life, the nature of which was not easily defined. However she had not become anorexic until her late thirties. This had followed in the wake of a very difficult time during which Lynda’s agoraphobia had caused her to be housebound. Boredom and depression had bought about the trendy towards compulsive eating and she had put on weight rapidly. Lynda who was rather short for an adult at only about 4th 10 had put on weight quickly reaching over twelve stone to become a size twenty. One day whilst trying on a new skirt a button had poped loose and shot across the room, the initial hilarity that first ensued quickly gave way to feelings of depression and anxiety. From that day forward Lynda went on a diet and never stopped.

After a while at the day hospital she did find it easier although there had been some uncomfortableness between herself and one of the other patient’s parents who Lynda thought resented her she assumed becasue of her age, that they considered that somehow being anorexic was not appropriate. But Lynda did some times imagine such negativity from others, a tendency toward paranoia a result of finding it difficult to sense other peoples emotions, difficult to fathom what people felt.

Besides the social interaction the business of staying there from early morning until late afternoon was problematic and rather boring. The idea was too eat especially prepared meals at the day hospital; lunch time consisted of huge sandwiches. Lynda became anxious always mindful of the amount of calories she would be consuming constantly compulsively trying to work out how to mitigate the effects by avoiding food at home. She did gain weight but only a relatively small amount. Her heart was simply not in it, it was as though she was always fighting herself. The urge to be slim was so powerful it overshadowed common sense, sapped motivation . After completing treatment she was still only about 7 stones previously she had been about 6 stones 4 pounds. Within months her weight once again gradually decreased.

Today was a particularly anxious one, Lynda dreaded medical appointments. There were various reasons for this but if treatment was invasive the greater her fear. Lynda had hospital phobia of a sort. But even if the treatment was fairly benign Lynda often became fearful for reasons she could not clearly define. Dentist phobia had been a huge problem during her entire life to the extent that she eventfully had to have her teeth removed under a general anaesthetic . Her anxiety over her appearance had overcome her fear of anaesthetics but for weeks leading up to the procedure she had been dreadfully depressed. She was afraid of dying as a result of the aesthetic, this fear haunted her regardless of the simplicity or complexity of the procedure. The anticipated fear when such was of necessity hung over her life like a shadow, following her everywhere the thought was there. Often she would put off such procedures dreading the post arriving should it be the notification of impending surgery. The fear of the dentist remained and at one time in later life she could not even bear to have a plate fitted, the mould in her mouth producing extreme anxiety with feelings as though she were choking. The dentist although with the knowledge that she had agoraphobia and anxiety had not been very understanding. Lynda found that few understood her anxieties . However concerning appointments like the optician she simply became so anxious that she often cancelled not really knowing the cause of this anxiety, perhaps it was simply an accumulation of just too many anxieties presenting at one time. Today again this anxiety was there. Although Lynda had made progress with her agoraphobia she still felt more comfortable less anxious if she was accompanied. In the past there had been difficulties, she could not ask her husband to take too much time from work, his employer had been very understanding but there was a limit. And sometimes even when accompanied Lynda simply could not face this and often cancelled only hours before she was due for her appointment. Today was going to be one of those days.

Lynda often rang her sister when she was particularly anxious and in the same way for the same reasons her sister often rang her. Her sister had OCD, depression and in the last few years a number of other conditions such as migraine and chronic daily headache. As sisters they where perhaps more close than is usual nowadays. They saw little of one another though, mostly as a result of their respective conditions but kept in touch regularly by phone and rang each other during times of crisis and every Sunday. It helped to share fears with someone who understood. Although both suffered with an anxiety disorder and both had obsessive compulsive behaviours , her sister full blown severe OCD and Lynda anorexia nervosa which she recognised in some ways was similar to OCD, also Lynda’s sister had even gone through a time of being borderline anorexic. Even if they did not understand one another’s conditions as such they understood the common feeling of anxiety, fear and depression that arose from their respective disorders, After all anxiety disorders get their name from the fact that anxiety is a symptom common to these conditions. Both sisters also shared hypochondriacal fears, both dreaded and feared anaesthesia, hospitals, invasive medical procedures, both had dentist phobia and both knew the difficulties and loneliness of social anxiety. In fact it was this problem that was the most defining factor that drew them together and brought about a closeness . Both sisters where of similar age, Lynda’s sister only eighteen months her senior. During childhood and still in adulthood both had difficulty with social interaction. Both where socially inept, awkward in company, tongue tied. Lynda in particular it seemed spoke her opinion regardless of its appropriateness this would often cause difficulties in her associations with others. Neither sister had had many real friendships, neither had integrated with her peers and would have spent childhood alone had it not been for each others company. Yes they had squabbled sometime quite seriously but in the end resentments and conflict would be cast aside, although Lynda had to always be the one to give in, her sister never capitulating .

In recent years Lynda had made some progress with her social anxiety after attending a day centre for the mentally ill. She had made a friend with whom she felt close but she had also upset one or two people one in particular had been a rather difficult association. But defiantly Lynda had managed to improve and make one good friend who she would often meet for coffee or lunch. But notwithstanding such progress often her conversation was strained as though she had prepared a script for certain social occasions such as meeting a neighbour and asking about his or her health. Her sister had noticed how unnatural her interaction had been although she did not say as much. However compared to childhood there had been noticeable improvement.

Lynda recalled how difficult it was as a child, how fearful she had been of other children. At one time in the infant school Lynda’s sister had to join her at playtimes becasue she could not interact with the other children . The arrangement had occurred when she and her sister had been enrolled in a rather depressing drab infant and junior school . Lynda’s sister had been only too willing to comply with this arrangement having problems herself interacting with her peers in the junior department. Yes indeed social anxiety had drawn both sisters together and life indeed would have been lonely without each others companionship.

Having cancelled the Optician and talking with her sister she had felt some relief for a short while. She knew she should have gone as it had been the second cancellation, if it happened again she would most likely be charged for a broken appointment. But today despite talking things over with her sister she simply could not face this appointment, perhaps another day she would be less stressed although from past experience she knew this was unlikely and all the cancellation caused was procrastination and a repeat of the anxiety she had experienced during the last few days, an anxiety she often felt as an appointment came closer.

There are more things to alarm us than to harm us, and we suffer more often in apprehension than reality.

But today she had to go to college, surely a difficult endeavour without the added stress of this appointment. Although in recent years it had become easier to leave the house alone, she most often did so with a pounding heart, a lump in her throat and surges of anxiety. Maybe even a panic attack. There was no medication she could take to relieve such symptoms. In times past she had benefited from Nardil to some degree but not enough to really be free from the clutches of fear that was agoraphobia, but she had put on so much weight as a consequence of using this drug. Excess weight that had motivated her to diet to extremes due to the increase of weight as a result of this medication and also from the boredom and depression of confinement due to the severity of her agoraphobia. Also this medication had most likely been responsible for the tragic birth of a seriously deformed child who had lived for only twenty minutes. The entire pregnancy had been an ordeal from beginning to end looking back she did not know how she had coped. She had been extremely anxious and irritable snapping at everyone. Her fear made her this way, the dreadful fear of what to most was a happy experience albeit an uncomfortable one.

Nowadays Lynda was taking Lorazepam. This medication had long since stopped being effective however Lynda like many others had become addicted to this drug and although now on a low dose Lynda was unable to break this addiction. If she forgot her medication within hours she would be subject to quite severe withdrawal symptoms very much like the symptoms the drug had been developed to combat. On several occasions Lynda had forgotten to take this medication, overwhelmed with dreadful feelings very much akin to anxiety and she had had no choice but to return home. On a few occasions a new GP would suggest a programme of withdrawal but so dreadful where the symptoms Lynda did not feel that she could cope.

So there she was with no real help for her anxiety. The doctor had prescribed antidepressants such as Amytryptaline but Lynda was anxious to take this medication. It slowed down her system made her constipated. In recent years she had been in a car crash in which her mother was killed and she and Mike where injured, Lynda more seriously so. Her intestines had needed immediate surgery and although she had made a compete recovery this accident had been blamed for two bowel blockages which a few years later had also required surgery. Thereafter Lynda became anxious to take anything which slowed the movement of her bowels fearing a recurrence of this ordeal. An ordeal that she could not now imagine that some how she had been able to endure. The terrifying pre-operative procedure of having her stomach pumped to rid her stomach of digested food that could not be eliminated in the usual way due to this blockage was something that in her wildest imagings she would not for one minute have considered that she could have endured. Yet she did, but she dreaded the thought of a repeat of this nightmare, Lynda now lived in some apprehension about this happening again, any difficulty or signs of constipation sent her into a panic.

One year when visiting her sister which was a rare occurrence, due to her agoraphobia it was an ordeal of traumatic proportions, she had not had a bowel movement and a panic induced visit to the local doctor in he village where her sister husband and son lived was arranged. He had been less than understanding but there again Lynda had not explained the reason for her fears. Lynda had problems explaining herself, she like her sister was tongue-tied, often she would neglect to explain the situation not knowing quite how to do so. Often in such situations the result was that her circumstances were never adequately explained nor consequently addressed.

Often when such trips where planned the fear would be so overwhelming that often right at the last minute she had got Mike to ring and cancel. She knew her sister would be disappointed but Lynda was secure in the knowledge that she would understand her fears, the dread of leaving her softly zone. Most agoraphobics have a softly zone the periphery of existence out of which they fear to venture. In extreme cases it can be the sufferer’s own room or even the bed. Lynda had a pen friend, a fellow agoraphobic who could not leave the confines of her bed. Lynda could now albeit with Herculean determination leave her home but leave the familiar areas within the boundaries of the city was still for the most part out of the question. There where occasions that she would visit a nearby village or other local place of interest but these trips where fairly irregular and never ever alone. Travelling further than these places was a terrifying experience Lynda would be so overwhelmed with fear that on many occasion she would either cancel the arrangement at the last minute or turn back half way. She recalled once having booked holiday in a welsh seaside resort how the fear had built up the further the car in which she was travelling took her away from her safety zone until finally she could bear the anxiety no longer and asked Mike to turn round and go home. She than had than to sufferer the torment of guilt, Mike had looked forward to this holiday, he was of course disappointed although he did his best to hide this feelings. Lynda was nonetheless consumed with guilt about this problem despite the fact that she could not help the way she was and did not react the way she did with any intention, in fact she hated this impediment to a full life.

Lynda like any other sufferer imprisoned with in the constricts of her mind wanted freedom to be like others to travel at will without trepidation. The Wales holiday in particular had been a huge disappointment, Lynda had fond memories of childhood holidays there and she like her sister had an affinity for North Wales.

Lynda prepared herself to attend her college course. Often getting ready to go out presented its own problems with anxiety concerning her appearance, taking half an hour to apply makeup and indecisiveness about clothing also added it own brand of stress and depression. Lynda lacked self esteem fussing over her appearance, still after all these years anxious that others saw her as unattractive despite the contrary as even with the approach of late middle age she was still attractive in spite of her gaunt appearance. Lynda often thought that people stared at her and worried about this often getting verbally aggressive and out spoken. Yes she seemed oblivious to the fact that people did not stare becasue she was unattractive but rather becasue she was so thin. Yet she failed to see this thinness nor the fair downy hair which grew on her face despite her sister having remarked on this due to concern about this common manifestation of malnutrition.

Today as most days she would go alone leaving Mike to fiddle with his computer. At such times he appeared to be in a world of his own thoroughly absorbed by his new hobby. However he had helped Lynda with her City and Guilds course finding information and ideas on the internet for the various exercises Lynda had to complete to qualify for her certificate. Mike was fairly good at organisation at least this aspect of organisation, in other respects such as tidiness however the opposite was true and with Lynda’s tendency towards almost obsessive neatness and order there where conflicts. Nonetheless nothing serious as on the whole their marriage was sound. Mike had supported Lynda throughout and in some way she had supported Mike but it had not been easy and after many years of adversity there was of course some friction but on the whole they where both supportive of one another.

However it pained Mike when Lynda became thinner, particularly after treatment, but he just did not know what to do and at times he appeared not to notice but he was simply lost as no manner of reasoning or persuasion ever changed anything. If under pressure Lynda did eat food that she forbade herself to eat she would be depressed or anxious. She once told her sister that just eating a sweet, one boiled sweet would make her so anxious as she felt as though the weight was piling on before the last trace of sweet was even ingested. No one could alter Lynda’s mind set concerning food not even the threat of damage to her heart. Her sister had read about anorexia nervosa and had learnt that when the condition became entrenched that damage to the heart could result, the heart would shrink and change its position. Lynda even if she had been monetarily anxious about such well meaning concerns continued to diet impervious to threats to her health. She often said that she craved food as though she did not make the connection that it was in fact okay to give in to such cravings for these were not the cravings of a compulsive eater but the cravings of her undernourished body. Mike indeed had been patient some would say that he had enabled. Rushing out on a cold winter’s night to get some of Lynda’s special low calorie drinks on Christmas day on one of these rare occasions that they had stayed with Lynda’s sister becasue of Lynda anxiety that she had just the right type of food or drink. On such visits Lynda had been anxious about food preferring to take her own or shop for her requirements. Her sister she felt did not really understand this and at times visiting had been rather a strain because of this. Some times her sister’s and her own obsessions would be incongruous, at such times and there could be a little awkwardness. Lynda became annoyed when others tried to get her to eat as it seemed as though they did not understand. Mike had been understanding to a good degree he had even been patient with Lynda’s insistence that he stick to a healthy eating regime. As a sufferer of high blood pressure and angina Mike needed to be careful of what he eat but Lynda could be rather dogmatic and dictatorial in her insistence concerning Mikes diet.

As the course was now in it’s second year Lynda’s schedule was quite hectic. There was an open evening exhibition to prepare for, also her final piece of patchwork was required in only a couple of months. This would be the main piece by which most of the course grade would be based. After much deliberation which sadly had brought about its own measure of anxiety Lynda decided upon an African theme, a mixture of patchwork and appliqué.
Link: Africa theme quilt. This was a huge task and an expensive one. To create such a quilt would be very costly indeed and on their low income this was a concern. But Lynda had come so far, had overcome so many difficulties there was no turning back. The course had not been straightforward some of the more abstract ideas had not come easily at all, but somehow after much support from Mike and the course tutor she was now at this final stage.

Although the course had done much to strengthen Lynda’s self esteem it had been difficult in a number of other ways. Her perfectionist tendencies had been a terrible torment. On at least one occasion the course tutor had been dumbfounded when Lynda insisted on commencing a new project as she was not satisfied with the standard of work she had produced despite reassurances from her tutor that she was doing just fine and the work was to a good standard. Moreover it had taken weeks to become used to her fellow students. Her social anxiety and indeed her agoraphobia had been no easy matter both to contend with and both had played their own respective roles in making a difficult task seem at times impossible. Lynda had commenced the course alone. Her new found friend from the mental health centre seemingly uninterested in taking a more serious course for a qualification. But since doing the patchwork course with the mental health group Lynda had become enthused with patchwork, it had become an obsession, a passion. Although a positive one rather than a negative one she had to admit to herself that perhaps at times she was over zealous and there was anxiety if she found that for some reason or another she would not be able to work on her patch work. She on occasion would also become irritable even angry. One such occasion was when her sister and husband visited briefly. Lynda had loathed to leave her hobby over the weekend and had arranged to work on a piece by hand during her sister’s visit so that in some way she could involve herself with her hobby but in a less noticeable way that would not appear rude.

Courage is resistance to fear, mastery of fear – not absence of fear.
Mark Twain

Finally on this bright autumn morning Lynda was ready to go. Although she was enthusiastic concerning her course and she could now cope with her agoraphobia and social phobia sufficient enough to make the journey alone and when finally arriving to interact well enough to have made a firm friend and one or two acquaintances, none of this had come easily. There was always that dreadful feeling of trepidation. The fact that she had to get to the course in the mornings when she was still effected by that dreadful free floating anxiety that often took some hours to subside made matters worse. Yes she could now make this journey alone but it had taken several weeks to do so, but with time it had become easer but not easy. Leaving her apartment was in the beginning an anxious task in itself. When she and Mike had first moved here Lynda had indeed been shy and dreaded opening her front door should she be confronted by a friendly or sometimes sadly not so friendly neighbour. But now she knew most of the residents, those she did not know or avoided for some reason where now of no concern. Nonetheless there was as always that feeling of apprehension which increased as the door slammed closed behind her and she made her way from her apartment block down the street to the bus stop.

It was not a particularly quiet area, a duel carriageway ran past the window, but the street was lined with trees and there was pleasant looking houses with attractive gardens opposite. Further down the road though this gave way to rather a mix of warehouses some abandoned boarded up offices and intersections of busty traffic filled roads, although there was a park a short distance away but which they rarely visited.

Today was a most pleasant autumn day the leaves where a glorious display of vivid oranges and browns, the sun was warm it was one of those Indian summer’s the final spate of warmth before the onset of dreary cold winter days. Lynda shivered though despite the clement weather. Even on the hottest of days Lynda was cold. Her apartment was heated to an extreme degree, at five in the morning the heating came on, stifling unbearable heat. Mike found if suffocating as did her sister during the occasional winter visit. Her sister’s house was always frigid her sister was not used to such overpowering heat. But Lynda felt the cold even in the spring and summer the temperature had to be hot exceptionally hot for Lynda to even feel comfortable.

I can do anything you want me to do so long as I don’t have to speak.
Linda Evangelista

Waiting at the bus stop was always rather an ordeal. Would someone strike up a conversation. Lynda had overcome her shyness to a degree but scoial interaction did not come naturally. Often if the bus was late Lynda became more tense. To get to the college she needed to catch two buses, one into the city centre and from there another to the other side of the city. A feat that just a few years ago she would have thought impossible . Yet here she was now waiting at the bus top just like any other person going about his or her business. Except unlike most people she was anxious, her stomach churned a lump rising to her throat, her heart pounding with strong palpitations. Going out for Lynda would never be easy, common place and done without a thought, not accompanied with anxiety. Even though she could manage to cope with her agoraphobia there was nothing she could do to prevent a sudden panic attack which came quite out of the blue and if severe may necessitate her return home.

Struggling through the throngs of crowds was stressful, people rushing with frantic haste could at times be disconcerting along with the cacophony of noise that nowadays seemed to forever increase in volume. The blare of noise of music turned up at high volume bursting out of shop doors as she hurried passed , the din of traffic all merged into a convulsion of sensory overload and Lynda rushed to catch her connection and get to the more peaceful environment of the college. Not that there was much peace to be found anywhere nowadays particularly for those so sensitive to every nuance of sound. The babble of chatter, the slamming of doors, the tap tap tap of feet down the echoing corridors all jarred Lynda’s nerves adding their own measure of anxiety. The first few times Lynda had made this trip it had been enormously difficult, the strangeness of her surroundings, and it had taken weeks for Lynda to extend her safety zone to become acclimatised to taking this journey and being in a  place of which she was not familiar. Yes again as time went on the situation improved somewhat and now in her second year things had become much easier but never easy.

He dare not come in company, for here he should be misused, disgraced, overshoot himself in gesture or speeches or be sick; he thinks everyman observes him
Richard Burton

Arriving and entering the class room was invariably anxiety provoking even after so much time had passed. Greeting her fellow students was always difficult, some responded to the usual pleasantry of Good morning but many did not engaged in conversation or other distraction not realising to a person with scoial anxiety that this appeared as a brush off, an indication that she was disliked or not noticed. People where just oblivious that such a day to day occurrence as social interaction was an ordeal for some. But now Lynda had at least one close friend Marian. Marian was a little older than Lynda but of a very youthful appearance, an elegant self-assured lady. They had a good friendship and Lynda was able to confide in Marian but sadly Marian did not understand about Lynda’s anxiety at all. Marian was very self confident for the most part had few worries and little anxiety or stress in her life and therefore little empathy. Lynda once remarked to her sister that during a visit from Marion the council turned up to cut the grass and she became so very anxious becasue of the noise that Marian remarked with some surprise: “Really Lynda! Surely you understand that the grass has to be cut.” Such comments irritated Lynda, the frustration of trying to get others to understand her plight at times seemed impossible and often she wondered if people thought her weak, surely she thought they should realise that she did not want the problems she had and she would be rid of them in an instance if only she could. She did not behave this way deliberately. Notwithstanding such incidences theirs was a workable relationship albeit somewhat strained at times. Although Lynda found it difficult to really develop a close friendship with anyone and oftentimes found people annoying.

The lesson as such lasted for about two hours although there was more work and home assignments to be carried out including the completion of the quilt. Lynda really was anxious about this, time seemed to be racing by. She needed lots of encouragement which was forthcoming from the tutor who continually praised Linda’s efforts and abilities. But nonetheless Lynda could not be convinced of her talent in this craft. Not even when less able students sought her advice including her friend Marian who was less enthralled with the course, less involved, less serious, it was more for Marian a way to pass the time rather than a genuine attempt to improve her skills.

The way you overcome shyness is to become so wrapped up in something that you forget to be afraid
Claudia Lady Bird Johnson

Lynda seemed more able to cope here than in other similar situations many of which throughout her life she had abandoned if she had even commenced them at all. The only real difficult time was tea breaks. Lynda would complain to Mike when she arrived home how ridiculous it was for a tea break that lasted for nearly forty minutes during a tuition period of only two hours. Lynda felt it a time waster but more importantly if was an anxious respite when the need for conversation arose, at such times Lynda was tongue-tied for the most part. During the actual lesson it was much easier as the sole topic of conversation was of course patchwork. This was a serious course with a qualification at the end of it for those who worked hard to improve their skills, it was no mother’s meeting or social chit chat over tea. Yet there was this long extended tea break which interrupted the flow rather and left Lynda feeling awkward and such increased her anxiety. Moreover cakes and biscuits where often passed round. Lynda invariably declined and felt there was pressure to have a cake or biscuit, sometimes she imagined that this was deliberate as if the group knew of her anorexia and that they wanted her to be as undisciplined in their eating habits as they themselves where.  Lynda found it difficult to cope with other people’s insistence sometimes it was as though people invariably thought that whatever they where doing you should do likewise. Lynda would often remark to her sister that If only everyone was more tolerant, than everyone’s disabilities, likes or dislikes, personal preference or opinions would be treated with respect. But generally these where a pleasant group of ladies and notwithstanding these difficult scoial moments this was the first time in her life that Lynda had felt part of a group. The first time that had become involved with others so closely and doing something that she enjoyed which meant something to her, something that she could achieve. Her patchwork had made quite a difference to her life even though most facets of this endeavour had their own set of stresses anxieties and tensions.

Today indeed the lesson had been rather anxiety inducing, the tutor focused upon the final requirements for qualification and arrangements for the exhibition of work. The completion day for her quit was still a couple of months away but the exhibition was fairly imminent in a week’s time. Lynda still had a long way to go towards the final completion of her quilt but even she had to admit this was in part due to her perfectionism having to have it just so. Yes of course the work needed to be of an high standard but in her tutor’s opinion Lynda had already exceed that standard. Lynda had a difficult piece to complete and today needed the tutor’s advise. Although Lynda was more confident now than she had previously been she  nonetheless experience some apprehension, a mixture  perhaps of social anxiety and fears that she would never manage to sort out to her satisfaction this troublesome piece of work. The tutor it seemed did not see that there was a real problem remarking that Lynda worried far too much and needlessly so as her work was excellent.

After the conclusion of the lesson and the taking note of new assignments Lynda said her goodbyes . She arranged to meet Marian for a coffee on another day later in the week and after a brief chat she left to make her way home with the increase in anxiety that always happened right about now. She would stop off in the city centre between catching buses to check out the cloths. This often increased her depression. Financial considerations where always a problem. Life it seemed was invariably a struggle to make ends meet for anyone with any disability and Lynda was no exception. Although she had made some progress she would never be able cope with a full time job and it and been expensive to enrol in the course. Although the tuition fee was free to people who where on disability benefits the coast of buying materials had been significant.

Lynda had such low self esteem that no matter what she bought, new cloths, make up whatever she was always anxious concerning her appearance. There was one shop she would not go into to try on cloths. The mirrors in the changing rooms where positioned in such a way one could see every angle of ones figure. Lynda hated herself hated what she looked like. Despite being about 6 stone four pounds she felt fat. She would remark that the mirrors in these shops made you look thinner than you where so that you would feel you looked good in the cloths and buy them. This may of course be true to some extent but nonetheless there was no denying that she was painfully thin. Yet she could not accept this. Conversely there where times however when she would examine her frame, when she took a strange delight in seeing her collar bones stick out and her ribs protrude. Was this becasue she thought this attractive or was it that it was a visible indication that she had control over her body. Control that other people it seemed did not have. Only Lynda knew this of course, occasionally she confided both of these rather incongruous mindsets concerning her anorexia to her sister. She knew she was anorexic of course. She knew it was not normal and there where occasions when she wished she could eat this or that with happy abandon but at other times it appeared as though she relished this condition and wore it as though it was like a medal, a badge of honour an indication of achievement.

Most days she stopped in the shopping precinct to sit on the bench there and eat her sandwiches, slowly relishing every bite. Contrary to popular belief anorexics crave food. Anorexia is an obsession with food in a way, controlling food in one way or another. Lynda often felt so deprived fighting the dreadful cravings. But when she did eat what little she ate she did so with careful deliberation. Today though her peaceful contemplation and enjoyment of her meagre midday meal consisting of two thin slices of diet bread, a scratching of low calorie margarine and lattice she was interrupted by the chatter of a woman whom she did not know. The lady an overly friendly person sat down beside Lynda and began to chat away as though they had known one another all their lives. Lynda could not bear such interruptions and abruptly said to the women : “Do you mind I am trying to eat my sandwiches.” the woman rather taken back left mumbling how it was true that people in Leicester where unfriendly. Lynda did feel guilty about this and later when she told her sister her guilt increased. Lynda could be abrupt at times, maybe it was due to shyness, being tongue tied. On this occasion she simply wanted her focus of attention to be on her sandwiches and she had considered this an unwanted intrusion. She knew her sister also had a tendency to be outspoken having at times a shocking temper but nonetheless would probably have not been as rude for no provocation other than irritation. Lynda could not understand her sister who often made Lynda feel rather guilty from time to time and there were occasions when she did not always tell her sister everything during their weekly Sunday morning chats , at least not for some time for fear of condemnation which even if it was not said in so many word was implied. But after a time Lynda could not keep such things to herself, she had never been good at keeping confidences or secrets about anything. Sharing quite openly confidences which were probably best kept to herself.

Finally returning home there was a little apprehension as later in the afternoon she would be required to present at the ladies sewing circle which she had of course organised. This was most definitely a first for Lynda, never before had she ever undertaken anything of this nature. Patchwork was her passion, some would say an obsession, and this obsession had brought this about although she could not quite recall how the idea first started. It would seem that her hobby had been of considerable therapeutic value, indeed it had motivated a person of a very nervous disposition who suffered with agoraphobia, panic disorder, and social phobia to achieve things that once she could only dream about. The group was only small, a half dozen or so ladies none of whom had any previous skill in this craft therefore Lynda took on the role of tutor rather than this being a mutual appreciation of the craft of patchwork.

Nonetheless Lynda was always a little apprehensive however she and her husband Mike had struck up a friendship with two of these ladies and they had all four of them even been on holiday together. Another remarkable achievement for Lynda. Naturally this had not been easy and the warden of the complex had taken them all in a mini van, on arrival Lynda had panicked wanting too return home. The warden refused and incredibly Lynda stayed. At first she had been apprehensive not pleased at all, although of course had she insisted he would have no doubt complied. It had taken a couple of days or so for Lynda to acclimatise but gradually her anxiety waned. The other ladies where only vaguely aware of Lynda’s anxieties and perhaps because she had to keep up a certain facade this in some way helped her to cope with the fear. For no mistaking, fear of this nature is severe pervasive and a struggle of Herculean proportion.

Approaching the apartment block was always somewhat nerve racking. The communal lounge faced the entrance and at certain times of the day a group of residents would sit there often commenting amongst themselves concerning the comings and going of their fellow residents. Lynda knew this as she had been there on one or two occasions. But this was the way of the world as sadly when groups of people are in close proximity and there is little other forms of occupation available. But notwithstanding such exceptions most of the residents where affable.

Lynda went to the group which met in the lounge at about three in the afternoon. It was only for an hour or so. None of the ladies had done any kind of patchwork but most with one exception where able to learn the very basics. The exception was May a lady who was somewhat slow and also dysfunctional in many ways not easily defined. Not able to organise herself to pay her bills, spending money on cigarettes and finally being cut off and having no gas or electricity. She had no relatives and Lynda helped her out from time to time but with sad consequences. This lady was really not up to the task and she found it rather stressful as she was neither a professional tutor nor a social worker. But this woman seem so alone left to contend with problems of which she was unable to cope. The ladies where always grateful, yet none realised the difficulties Lynda faced or the anxiety that needed to be overcome in order for her to run this group.

Today the class was rather stressful, May immediately grasped for Lynda’s attention with a piece of patchwork that despite its basic simplicity she simply could not master. May who it seemed had a learning difficulty demanded a lot of attention and was not popular with the other ladies or indeed the residents in general. Lynda tied to help the best she could but at times found this lady rather trying. Finally Lynda promised to take May’s work back to her apartment to sort to out. May most likely came for the company . Notwithstanding this sort of difficulty Lynda coped very well and today chatted quite spontaneously with the other ladies . But after such a long and tiring day Lynda was pleased when the class came to it’s conclusion.

Lynda often became easily tired, after all it was exhausting fighting so many battles on several fronts. In addition to agoraphobia, social anxiety, anorexia nervosa and the occasional panic attack – and don’t forget that panic attacks came at anytime without warning this in in itself bought with it a certain amount of anticipatory apprehension – Lynda was subject to depression. Soul sinking pervasive depression. Nothing came easy. The addition of depression sapped a lot of Lynda’s motivation and it was only her enthusiasm and her perfectionist drive that at times spurred her on. Ironically it can at times be the obsessive illnesses such as Lynda’s anorexia nervosa that prevents some people from sinking into a prolonged mire of despondency. Had Lynda succumbed to severe depression she would not be in position to be so well organised in order to juggle her food to meet her daily quanta of 500 calories. However this did not mean Lynda was not depressed. Indeed quite often her depression was significant . Some days her heart was so heavy with the burden of unhappiness it took all her time to drag herself out of bed to face the day and there where times when despair threatened to interfere with her passion for her new found hobby. At times she was so depressed that she felt as though she could not cope with going to classes or attending the sewing group or doing much of anything.

The evening meal was the highlight of her meagre eating day and was prepared with an exacting attention to detail. Lynda put enormous energy and effort into preparing a meal with in the strict limitation of her self imposed calorie regime. Most meals consisted of piles of lettuce and a mixture of other salad vegetables, grated carrots and such like. A small amount of cottage cheese probably a little low calorie coleslaw but little of anything else, not even a slice of bread. Dressings where limited to low calorie salad cream. She would finish with a low calorie yoghurt. This eating regime sometimes caused other problems as it was expensive. Mike had noticed that Lynda obsessed so much about the calorie content of food that if there was a choice of two items, one with only a few calories less but considerably more expensive she would choose this regardless of the price and their low income. Sachets of low calorie chocolate drinks gave Lynda the sensation of fullness between meals and she craved these becoming anxious should they not be available. Lynda never compromised not even in a restaurant. Here she would order cottage cheese and salad. Even when her sister and her family came to visit and the went out to eat, while they ate such meals as mushroom flan Lynda would still only order cottage cheese and salad. Never ever seemingly tempted, occasionally taking a tiny spoonful from Mikes plate but never ever seriously diverting from her diet. She never begrudged anyone else eating, although she did make sure that Mike did not eat food unsuitable for his condition, even making a huge effort to sing the praise of this or that dish while she would sit and eat only salad.

After such a strenuous day Lynda still took the time to laboriously prepare and wash all the vegetables for the salad. The bigger the salad the better she felt even though in reality she was undernourished eating little of anything of any real substantial nutritional value. She had long abandoned the progress she had made at the day hospital, without the encouragement or the enforced eating regime she just could not fight her obsession. It was after all an inner battle, a civil war. She was torn between her desire to be thin and her need to be normal. The compulsion to be thin was just too powerful, it easily overwhelmed her half hearted attempts at normality. The feelings of anxiety concerning eating had never gone, her mindset concerning  her eating habits had not really been addressed. The therapy had simply been about an enforced eating regime which she had in any case never whole committed herself too. Without the support of the day centre her weight soon fell to a dangerously low level once again. Other people including her sister in an attempt to help Lynda gain a more realistic perspective concerning her eating regime had remarked about how terribly thin she had become, how that it was possible to see shape of her skull, particualry the indentations near the temples which where extremely enhanced her skin appearing stretched and drawn. None of this made the least bit of difference in fact at time she took such comments as an encouragement against her fears that she was fat despite her appearance.

This evening it was bingo in the lounge. Sometimes Lynda accompanied Mike but for the most part Lynda preferred to work on her patchwork. The days were passing all to quickly and still she fretted over the quilt and its completion. The phone rang it was nine o’clock. Lynda hated talking on the phone except with her sister. It was the friend whom she had met at the day centre for the mentally ill and just needed to chat, Helen was a very sensitive and caring person and they were now close friends, in fact probably the best friend Lynda had ever had, but Lynda was tried and exhausted. But guilt as ever and a concern borne perhaps of a sense of over responsibility and she would spend over an hour talking with this person at times feeling as though she needed someone with whom to share her burdens.

Courage is the price that life exacts for granting peace. The soul that knows it not, knows no release from little things.