Thank you for sharing these reflections, Miriam. I’m so happy to hear that you’ve rejected the bullshit logic that semi-recovery is the best you can hope for, and recognised the inherent instability of that state. Other people not noticing the lingering elements of illness are one factor that often makes it hard to sustain the conviction that more is necessary, and I’m really sad (though not entirely surprised) to hear that the professionals who supported you (bar one) were so blind to the difficulties and risks you were dealing with during and particularly after pregnancy. The story you tell about the ease of weight loss and relapse is, I imagine, a common one in many countries, and needlessly so, if health professionals were better informed about the realities of eating disorders.

As for your question about how it’s possible that you conceived and then coped with the demands of pregnancy and breastfeeding – well, the simple answer is: the evolutionary process. Those of our ancestors who were able to withstand famine and illness and reproduce nonetheless were the ones who gave birth to children of their own who in turn were more likely to be able to withstand famine and illness and reproduce nonetheless. (See my post on ‘You are not your genes’ for more on this.) But of course the evolutionary algorithm (copying with variation plus selection creates design without a designer) benefits, ultimately, the genes, not the hosts: our Palaeolithic ancestors whose babies survived despite severe malnutrition probably didn’t have particularly fulfilling lives. In the 21st century, thanks not least to the marvel that is reliable contraception, we have the privilege of deciding whether or not to procreate, and of weighing up the benefits and dangers of this and many other courses of action to our health and wellbeing. For only a tiny new window in human history, being able to raise a healthy child now no longer entails a compulsion to do so. In your case, that crystallises in the capacity to decide against having more children, and to enjoy all that that decision makes possible for the rest of your life, including delighting in being a mother to your happy healthy son.

So, thank you for your contribution to opening up the conversation on this topic. And keep working towards a more than partial recovery.

Emily

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