When Your Everything Is Not Enough

This post has a bit more of me in it than is usual, but I think my own experience may be of value to others who regularly read posts at the Eating Disorder Institute.

 Jam Zhang: Flickr.com

Jam Zhang: Flickr.com

I’ve often reinforced the fact that genes are not destiny, and that’s because it’s the truth. There’s an entire lineage on my maternal side with the genes that are linked to celiac disease but few of us have the condition. Genes are like literary tools in a mystery book: they might suggest foreshadowing, but then again it could be the reader is going to be thrown entirely off track by their presence, or perhaps they only had relevance to a subplot and not the main plot, and finally it might just be they served no purpose but to entertain.

But just as the arctic tundra is distinct from the alpine tundra is distinct the boreal forest, our own human living ecosystems thrive within a range and are brittle and resilient in their own distinct ways. And it is the relationship of our genes with our environments that shape the ways in which we might become brittle and the ways in which we might become resilient.

When I was a teen, I had orthodontic braces. It was done somewhat later than my peers because I had a traumatized tooth (from a fall as a kid) and the orthodontist was waiting to see whether the root would die or not (it did) before placing the braces. Unbeknownst to me, it appears I was someone who was predisposed alveolar bone loss when applying those kinds of forces on my teeth to straighten them. That, combined with a marked tendency to clench down hard on my teeth while sleeping and post-infection inflammatory responses that seem to be worsening with age, and my gums are now in a sorry state and I risk losing my teeth or having major dental surgery and bone grafts to attempt to save the teeth. I’m not there yet.

But at my latest dental hygiene appointment, it was made clear that things are trending poorly. I was really upset for a few days. I felt betrayed. I have always had impeccable dental hygiene. Because I am very difficult to freeze, the excruciating nerve pain that often accompanies fillings for me has been a great motivator for being absolutely rigorous about preventative treatment. I religiously have my teeth professionally cleaned on time, I floss and brush twice daily and I wear a night guard on my teeth every single night to try to minimize the damage of clenching as well.

After feeling my body had betrayed me then, as is my tendency, I felt fatalistic and wallowed in some good old-fashioned catastrophizing. Basically, I felt sorry for myself: “Of course, I will lose my teeth and be a frightening sight to little kids. I have all these chronic conditions with inexorable worsening inflammation and pain. I will age horribly, suffer and die alone.” Then of course I heaped on all the cultural moral implications our society places on how individuals look and the assumption of what a lack of teeth represents: “You didn’t take care of yourself, you had poor hygiene (ewww!), you were irresponsible, lazy and worthy of other people’s disgust.”

And finally, as I completed my process of assimilating the reality, I felt grateful and accepting. It’s possible I will lose my teeth. Everything that I, and my dental team, can do is being done to perhaps prevent that or at the very least delay it. But I haven’t lost them today and I feel very grateful for that. I cannot prepare in advance for what needs to be done should they fall out in any case. Worrying and being anxious for that day gets me nothing except worry and anxiety. As for my culture, well I’m not much of a fan of it in any case, so I’m capable of keeping its moralizing garbage out of my own headspace and heart.

There are of course a lot of “what if’s” I could focus on to keep me locked in fatalism and resentment. I could blame my parents for not forcing me to stop sucking my thumb as a child which may have avoided the need for braces. Or conversely, my parents could have persuaded me not to have braces later on. Or perhaps I could just have somehow avoided all the night-time clenching that started alongside full-time employment as an adult. But hindsight bias is such a misleading space to squat in. You change one thing about your past and what else changes with it? We don’t know because we experience time in a narrow linear construct where we also naïvely assume that we could keep all the good and magically excise the bad along that line from then to now. Even excising the bad of the past might have the unfortunate outcome of rendering you less resilient in the now in ways you could not possibly predict.

And there was one additional observation I made: I would know nothing of this possible future state had my dentist and hygienist not recently attended a conference wherein recommendations were made for specific x-rays to determine alveolar bone density. I gave my consent for those x-rays and yet had I not, then I would have been spared a lot of emotional processing of a likely future state for which there is nothing that can be done that is not already being done.                                  

And all this navel gazing brings me to the countless patients in recovery from eating disorders I’ve interacted with over the years. Some blame me for how their recovery processes went completely pear shaped (figuratively if not literally). Many more blame themselves for a recovery process that doesn’t seem to progress in the so-called right way, or worse just seems to go from one extreme crisis to the next.

I would never suggest that something as objectively irrelevant as losing your teeth is actually equivalent to some of the serious medical, emotional, financial and life changing crises that can occur for many during recovery from an eating disorder. But I can suggest that no matter the crisis, getting stuck in the damage of feeling betrayed, fatalistic and resentful adds insult to injury.

My experience is also a firsthand example of submitting to screening tests for which I did not assess whether I wanted to know and what, if anything, knowing would remediate should the results be less than ideal, before agreeing to the test (in this case checking alveolar bone density). Yes, this is yet another bias of mine that you can take or leave, but I have gained nothing by consenting to those x-rays except the need to process a whole bunch of anxiety and worry. Everything that can be done to save my teeth was already being done with regular excellent dental care, so the trajectory of treatment is no different before and after the x-rays.

So, if there is any what-if that I do take away from the experience it is that I must work harder to apply my prerogative for my own health outcomes by choosing not to know when that suits me best. I know that my medical mind is one that has no interest in pretending something is in my locus of control when it isn’t. If you don’t happen to know yet what your medical mind prefers, then I would recommend you get a hold of Your Medical Mind: How to Know What Is Right for You.

There are no assurances in life and in recovery. You can do everything and it’s not enough because it’s not all yours to control in any case. Just because all the excellent dental care in the world may not assure me a lifetime with my own teeth doesn’t mean that I would ever have been better off without that care. And hopefully no matter where your recovery effort might lead you, you will still know that a life in the grips of an eating disorder will never have been the “better off” scenario for you.