Saturday, January 10, 2009

"In between"

Final Exam: A Surgeon's Reflections on Mortality

I finally got around to finishing this book. If you can't read the small print in the title, it's "a surgeon's reflections on mortality." In the book, Dr. Pauline Chen writes about the paradox in medicine between caring for the ill and systematically depersonalizing the dying. Though the book is about medicine and mortality, there were a few instances where I thought eating disorders could be applied. The next two posts are related to the book.

I should first preface this with acknowledging that my head is in an okay space. It's not like years before when all I could think about was death. These days, those thoughts have lessened, aren't as powerful, but yet, I do still find death a fascinating topic!

Anyway, onto the blog post.

Somewhere halfway through the book, Dr. Chen talks about the difficulty in knowing when someone is really dying and when is the right time to "let go." She says one of the "misconceptions of dying, it is this belief--that death is a certain, discrete event completely distinguishable from life..."

She goes on to quote Doctors Joanne Lynn and Joan Harrold from their Handbook for Mortals:

Perhaps the classifications as "dying" is really more like height than it is like gender. Some people are clearly "tall" or "short," but many are "in between." Likewise, some people are clearly "dying" or "fully healthy," but many are "in between." In fact, most of us will die without having a period when we could readily be recognized as "dying." or "terminally ill." The new reality is that most of us will die from complications of a serious chronic illness that we will "live with" for years. There will only occasionally be a transition from the"living with" to a time of "dying from."

I found this to be quite a thought provoking quote which could be applied dually to eating disorders in the state of disorderedness and in recovery. In an eating disordered/disordered eating state, unless someone appears skeletal and emaciated, people are not naturally going to think they are physically dying, that they are living a "slow death." Although this has certainly been disputed as anyone can suffer from an eating disorder and we don't all have to look the stereotypical part, still, it's hard to define "dying." Thus, so many live in this "in between" state.

The same holds true for recovery. Recovery is like a spectrum. It seems only a small percentage reach the end to be considered "fully recovered." (I know that statement can be a bit controversial) However, most seem to live in this "in between" state of not yet truly healthy nor completely consumed by their eating disorder. It can leave many individuals in a constant state of flux and ambivalence.

Then, as the last part of the quote mentions, those who don't recover or even ones who are "functional" may wind up with the label "chronic." In this sense, it can mean living with the illness versus dying from it.
Neither seem like great options, so it's hard to tell whether one seems worse than the other.

If it is true that so many of us live in this "in between" state, how do we get ourselves fully out of it?

What is your opinion? Are so many of us living in the "in between" state?


Anonymous said...

This rings so many bells tiptoe, and I do think there is a large argument that you are in "recovery" forever even when you are "recovered", just like an alcoholic is an alcoholic forever even if they have abstained for years, or a diabetic is always a diabetic even if their condition is stable. But when to change from being in recovery to being recovered I think must be confidence in oneself. I'm going to choose when I feel ready to be "recovered" when the behaviours are gone, and then when I am ready to stop having to have "excuses" as such for being a bit odd around food. That's only make take on it, which is probably quite different to the professional view point.

Lola x

PS I'm fascinated by death too. It's another mental health sideeffect I think. If you face your death often enough, it's hard not to see death as being in the same context as life. It's everywhere, but life is everywhere to.

kb said...


I lived in the "in between" state for YEARS, I believe. After one stint in the hospital, I was determined to never hit that point again. And for better or worse, I did manage to stay healthy "enough", the depression that clouded me for year lifted, and I gradually expanded my life's experience and strengthened my relationships with people. I think that because I *did* value certain aspects of my life, this made it much more possible for me to get to the point where I find myself now, which is a far better place than I've been in 20 years (or so). I hate to say that I don't want to think of myself or of my life in terms of "recovered" and/or "sick". Maybe that's the taboo of living with a mental illness, but, sort of like life and death, I see these as related rather than paths that bifurcate.
Thanks for the provocative post!
- Kristina

Kim said...

Very interesting post. I really think that I've spent many years in this "in between" state -- not really alive or dead. It's sad. I also think that's just part of recovering...
On a sidenote, I'm also strangely fascinated by death (not in a depressing way... For me, it's kind of empowering to remember that life is short). If you indulge your interest in the morbid, check by "Stiff" by Mary Roach. It's interesting, and kind of funny in a way.

Gaining Back My Life said...

I believe there is a truly recovered state, because I was there for 4 years. Now, one could argue that because I relapsed, I was never truly recovered, but I would disagree vehemently.

And then, I think of the damage that has been done by the previous stint with ed, and how that may be 'killing me' onthe inside yest I have no idea.

Sounds like a very good read.

Tiptoe said...

Thanks for sharing, everyone.

Lola, whether your opinion agrees with the professional viewpoint or not doesn't matter. Your recovery is your own. I think you're right in that confidence does play a large role in "recovered."

Kristina, strengthening your relationships and expanding on life experiences were obviously important for you to get where you are today. That's a big achievement in and of itself, because it is based on choice.

I'm very glad that you are in a good place all around and not in that in-between stage anymore. It makes sense that you may not want to be the extremes of either recovered or sick, but maybe it's as you've said before "just content."

Kim, yes, so many of us are really in that in between stage which is just sad.

GBML, you can get to the recovered place again. You're fighting your way now, and that's all you can do.

kb said...


I thought of this post when I read an opinion piece in the NYT.
Here is the link - it doesn't exactly relate, but it may touch on some of the themes that the book does.

Tiptoe said...

Kristina, thanks for the link. The piece does make some interesting points. I've heard the theory that living is also dying. It's really profound, and I really like what he says at the end of his life--that everything would be ready anyway.

I think as he says, you really can use death to mystify life.