It is about to hit us. Or did it come and go? Whatever, I think it is time to be stopped. Years ago, no one knew anything about eating disorders. No one understood and knew how to recognise the signs and symptoms in either themselves or other people. This is no longer true.
I agree that people with eating disorders are stigmatised. ED awareness hasn’t changed that. In fact, I fear that ED awareness week normalises eating disorders and can make them “cooler”. Even doctors regard people with bulimia as young and silly; They regard anorexia as a vanity illness suffered by wilful and irrational people. The public still regards compulsive eaters as weak. The new rash of articles about men with eating disorders is helping to bring sufferers into treatment but these articles don’t change the general image of people with eating disorders as being mentally ill. Parents want to keep their children away from someone with an eating disorder in case of infection. You wouldn’t want to ask them home for tea.
Well-meaning people in their hundreds go into schools to teach Health and Education studies about eating disorders. We KNOW that this is not a useful way to do prevention. It does little to change the incidence of problems. In some cases makes the situation worse by sensitising vulnerable girls and boys about issues of food and weight.
Eating disorder activists don’t like to read this; but I publish the evidence in good faith. I know what kind of prevention doesn’t work. Many times I have tried to persuade a former ED sufferer not to go into schools to warn about the dangers of self-starvation or purging. If you tell someone not to do something, chances are they will.
When people with eating disorders get to an investigative journalist, they are portrayed in sensationalist ways. Does this help? Or does it enhance a sense of disgust and revulsion among onlookers. You even get a chance to hear about purging in 3D. Let’s face it, the symptoms of an eating disorder are unpleasant; people do terrible, unbelievable things to themselves because of their apparent fears of fatness.
People respond to this with fear and disgust rather than compassion.
I really get cross about eating disorder charities that run Marathons to raise eating disorder awareness. It’s one more excuse for sufferers to burn calories to remain thin. Why not do some good in local communities like pick up the trash or clean the beaches?
And, I’m worried about fetishism of eating distress. I wonder why we don’t have Depression Awareness Week, or Borderline Personality Disorder Awareness week? Self-harm awareness week? There are enough mental illnesses these days to occupy our thoughts every day.
What is this going to do to people who aren’t suffering from a mental health disorder? Feel left out?
Let’s have an informed debate about what it is helpful to communicate – such as who is really qualified to help people with eating disorders; or, how to help schools develop an eating disorder policy to protect the healthy as well as the ill. Or how to encourage young people to ask for help if they are unhappy – that usually goes before an eating disorder sets in.
I’m game for a reasonable discussion about this – contact admin@ncfed,com or reply on our Facebook page if you disagree.
A Manchester health trust apologises for turning away Hannah
Pearson aged 23 who is suffering from serious bulimia nervosa. Because she is
not ‘thin enough’ nor ‘bulimic enough’ she doesn’t meet the criteria for an
urgent appointment. She is on a waiting list for treatment and the Trust says
it does not have enough funding to meet demand. Today I spoke with a few
colleagues who are giving everything to help people with eating disorders in
the NHS. It is the same old story about
waiting lists and only being able to help the sickest and the most difficult
cases for anorexia, bulimia and binge eating associated with severe life-threatening
obesity.
Everyone is a deserving case whatever their weight.
I set out my stall. I am passionate about getting people the right treatment and I spend my life trying to help people with eating distress. But I don’t think that anyone is thinking straight when they make complaints about long waiting lists as if it a problem that can be solved with just a little more dosh..
I hear that there are promises to step up to getting more help for eating disorder patients. The promise is great and the problem is HOW. If there was enough money to both treat all patients in need and to pick up early cases before they get sick (clearly the best option) we would need £ BILLIONS to meet this demand. Every year. These £ BILLION would be spent on appropriate mental health prevention programmes; a whole set of new buildings for Camhs and adult services; specially trained nurses, psychiatrists and psychotherapists; eating disorder qualified nutritionists or dietitians who know how to talk to patients with eating distress; and in/day patient places in hospitals.
Oh; and we need thousands of ancillary staff on permanent call to stop patients from doing the things that anorexia makes them do, such as water loading to deceive their weight or pulling out a feeding tube.
Because sadly, many Ed patients who are very ill get their treatment but they fight tooth and nail against their helpers. Sometimes physically. Eating disorder patients deceive their carers and helpers, aggress against therapists and pretend to comply with meal plans that keep them safe, refusing to embrace the idea of change even if they want to. This is the nature of this terrible illness. One young sufferer getting the best possible help at the Maudsley told her carers ‘I would rather be happy at 35 kg than unhappy weighing more’ – and die she did, of the complications of her disease, having cost the NHS a pretty penny for a treatment that failed her. Sufferers cannot be blamed (so no trolls please), because anorexia and sometimes bulimia are forms of madness with vicious, intrusive thinking making a person rather stay ill or be dead than be– in their own minds anyway – ‘fat,’ where fat is often just a delusion of the illness.
So eating disorder treatment is thwarted by the illness itself, where beds and access to help is blocked by a never-ending revolving door of need and money flowing out like a river. Services respond by letting sufferers go – even though they clearly need more help, possibly for a lifetime. But there are also other needy people pounding at the door of the money tree. One might think that this could be solved by finding better treatments, but even this is not a question of spending more money. We are spending plenty of money and not getting as far as we would like.
We do better with the overeating disorders like bulimia. But, despite all our efforts and our real-time experience, despite millions of pages of well-funded research, there is no known treatment guaranteed to work for anorexia. There never will be. People with anorexia need to try everything before they find a fit; most will eventually find a fit and recover, some do it by themselves, some never get well. Actually, most sufferers recover in time although the illness leaves a lot of scars. I never lose hope nor put my head in the sand that there is a magic bullet and that one day we will find it.
We cannot blame the poor old NHS for failing the public. There are too many people needing help. The NHS is groaning under the weight of having to provide medical and social care for an ageing population, treating drug addiction, confronting cancer. The NHS is a victim of its own success in keeping us alive. Mental health problems are a feature of affluence and no one wants to make us all poorer. A small increase in funding will do nothing at all.
Because there is no point providing access for help if the people who deliver it just aren’t there. It takes half a generation to get specialist psychologists, psychiatrists and health professionals like nurses and dietitians with the right academic training; who know what they are doing with people who are at war with food. Money won’t get them off the production line any time soon. How will we find (and fund) the places to create the 5000 new clinical psychologists (7 -year training) and 1000 new eating disorder psychiatrists (10-year training) to fill the provider gaps. This is always going to leave big holes in service provision as mental health suffers spend time bonding with a healer and then the healer needs to go elsewhere.
So what we need, at the very least, is a conveyor belt of super- effective therapy for eating disorders and other mental health issues, so that new sufferers can enter the system fast as other people leave it, but mental health is not that simple to address.
Activists and journalists always point a finger somewhere for a failure of what they think is a lack of care, lack of attention, lack of priority or failure to spot early cases. Even experts can not spot early cases because dieting is common. Eating in your room or being angry and withdrawn are normal adolescent behaviours. Behaviour that we used to call quirky, such as becoming a vegetarian, is both a symptom of an eating disorder and also mainstream. Activists make a big noise about not enough money being spent (true; but there will never be enough) and that we don’t know enough about treatment – which is a dangerous falsehood.
The real truth is that people who care about eating disorders (thousands) have spent their lives and their professional experience researching what works for eating disorder therapy and learning from the real people who enter our services.
When it comes to accessing treatment, I say; yes, it’s hard, but you are competing with a cancer case, a child with autism, a patient with post-natal psychosis and an alcoholic . You don’t just need to go and see your GP. If people are worried about their loved one, one has to ask why not turn to the Independent sector where there are many professionals with varying levels of training ready, willing and able to offer support. The argument that it is ‘costly’ doesn’t hold water. What price can be put on someone’s life? A proper assessment costs £65 with us at least. Therapy can cost less than an annual subscription to a mobile phone or your subscription to Sky.
6 months of valuable therapy at whatever the costs can give a person back their life. I am shocked that the sufferer here did not reach out to the private sector – if she did the article in The Times doesn’t admit to it; it just targets the NHS again, which is not helpful. Until we accept this, we are all tilting at windmills and not thinking straight.
Anorexia Activism, is it shooting in the right direction?
A former sufferer 20 years duration, has an article in the Guardian pressing for more investment in anorexia treatment. In theory why not. She has seen people die (of course, they do) and attributes her recovery to her psychiatrist, Dr Ayton, whose writings inform our own work with people who have anorexia.
I pointed out that we are already investing £millions on research into anorexia. In addition, we healers read the textbooks written by people like Dr Ayton and all the research worldwide. We go to conferences and we call upon our lived clinical experience with sufferers and their families.
It is not enough. People still recover, even after years, they will continue to recover and some will die, no matter how much money we invest. As one of my colleagues pointed out, more motorways don’t reduce the traffic. The problem with anorexia is partly clients themselves, fearing recovery and resisting treatment, often attacking the therapist, verbally or, physically. We understand that this is a symptom of the illness but we are just human, we have to be so lovingly strong and patient.
One of the followers of Lorna Collins was angered when I pointed out that money IS spent, people ARE being trained, books ARE being written to help the healers, and there ARE enough awareness campaigns. She was scathing when I mentioned textbooks and suggested that I was being rude about recovered people. But who writes these books? The writers of textbooks are people who want to share their knowledge and wisdom about the disease.
We know why people get better. Sometimes it burns itself out, sometimes people decide they don’t want the monkey on their back anymore, sometimes they fall in love and want to get better. And so on. The textbooks AND our experience tell us lots of reasons why people recover and we have more than enough anorexi-ographies to boost our understanding.
The outcomes for specific therapies like CBT-E, FBT, DBT or Mantra still are worse than we would like. People slip through the net. This is not attacking hope, its the truth. Hope is that people recover sometimes after many years each in their own way.
If Ms Collins recovered because of the work of a particular psychiatrist, then she knows at least why SHE got better. It was a specific therapist, not a treatment protocol. How do we bottle the personality of a specific psychotherapist? And will it work for everyone?
When people recover from anorexia, many become activists. Activism can, at times, turn to aggression when the activist is not willing to listen to other points of view. Agitating for more “investment” in anorexia is not going to achieve much (where is it to be spent?) and will leach resources from other mental health problems. Anorexia is a very particular mental problem, which has existed for centuries. It is foremost a disease that reflects the struggles of being human.
Binge eating disorder is an eating disorder that makes
people very miserable. People suffer for many years before admitting that they
need help.
People who come to us sayI don’t really have an eating disorder. I am just greedy, orI have no willpower. They blame themselves. This is wrong. If you are able to spend just one hour of your time with us, we will explain why you lack control with food, and what can be done about it.
Binge eating disorder can take many forms, it can be picking, nibbling all the time, or it can be mindless bingeing on large amounts of food. Binge eating usually happens in secret and it can cost you a lot of money. Very few people binge on celery sticks. The most common binge foods are those which are normally forbidden, large amounts of chocolate, biscuits, toast, cereal. Sometimes you try to put off a binge but have to get it over and done with. Sometimes whatever you eat is never enough.
You know by now that losing weight on a diet was never enough to stop you from binge eating. So there has to be another way to regain control of food. The way to regain control is not to talk endlessly about your early life, and it is not taking tablets for depression. You are depressed because of the eating disorder. You don’t binge eat because you are depressed or because you are simply comfort eating.
Help for binge eating disorder is just a phone call away. There is a wonderful, effective psychological treatment for compulsive overeating. It is not a quick fix, but it will change your relationship with food long-term. It can be hard work but it can also be fun. A properly trained eating disorder therapist can put this misery to an end.
If you would like to know more about binge eating disorder help for you personally, consider a one-off confidential assessment. Help is just a phone-call away; call 0845 838 2040.
So many people contact us and say that they are interested in bulimia nervosa treatment. First let’s be clear about what bulimia is. Bulimia Nervosa exists in people who are very concerned about what they weigh. They usually feel out of control with food at least some of the time. They binge eat, usually foods that they think will make them fat.
Then they throw up and / or take laxatives to try and avoid weight gain. We call this “purging” and there are many other ways to purge, all of which can cause great harm.
Even over-exercising to prevent weight gain after overeating, or using diuretics, are ways of purging to avoid the effects of eating. It doesn’t really matter how much food you eat, nor does it matter how often you purge. If you do any of this at all and if this is happening in secret, you are suffering from Bulimia Nervosa
Some very thin people purge, even though the amounts of food they eat are small. They might be suffering from Anorexia rather than Bulimia Nervosa. Bulimia nervosa is an illness which can be treated with the right kind of help.
Some people have very mixed feelings about accepting treatment for their bulimia. They worry that treatment will make them fat. No, it will not.
Or they feel that their bulimia is a kind of friend, it
helps them get through the day, it helps them to feel calm because nothing else
does. Bingeing gives them a kind of comfort and purging gives them emotional
relief. We understand all this too.
Bulimia treatment is a two-sided process. On one side, we will stabilise you physically, because as someone with bulimia, you gain weight easily and you have cravings for food that are hard to manage. You are unhappy in part because purging leaches away the neuro-chemicals which make you peaceful. We can teach you many new skills that will make it much easier to live in a world full of food and we will not judge you if you have to purge.
The other side of therapy is called enhanced cognitive-emotional therapy. This allows you to experience a deep, compassionate healing process which is hard to explain in just a few words so I will try to make it brief.
You will learn how to manage dangerous feelings that are being controlled by your illness. We may need to deal quickly with adverse events that have happened to you, so that you will feel more at peace with yourself. You will learn to be emotionally stronger than you have ever been before.
This therapy also attends to your mindset and to your self-worth which has been damaged by the shame and secrecy of the bulimia,. We attend to your thoughts about your appearance which are at the heart of your struggles with food.
Bulimia nervosa treatment is not just removing symptoms. People who complete this treatment feel happier, their life is transformed and they look forward to the future and to all that has opened up for them. One word of advice however. Bulimia treatment can only be done properly by someone who has been trained in eating disorder psychotherapy.
Many counsellors will tell you that healing is achieved through an accepting relationship. They may be wrong. The therapy relationship is important, and you need to work with someone you trust and you know that he or she understands eating disorders properly. But the relationship is not enough. An eating disorder specialist has learned a lot of additional skills and tools to set you free from your struggles with food.
If you want to consider having a one-off assessment with someone who cares and who understands eating disorders completely please click here. Or call us on 0845 838 2040 just to have a chat.
Very few people really understand how to treat anorexia nervosa. This is why so many people who need help fall between the cracks
First you need to understand all the treatments and what they do.
Second, you need a therapist with the skills to use these therapies and the emotional strength to help people who may not wish to change.
The therapist will need emotional qualities of firmness with compassion and who knows how to talk to the anorexic Voice.
If you need treatment and you have been consigned to a waiting list you can get help in the meanwhile by getting us to build you a scaffold of support.
If you want to know more about treatment, click here and remember help is only a phone call away.
Watching Jesy do her programme on body trolling, all of us here were nearly in tears. How brave of her to do this and I hope that one day she will look back on this time and feel good about herself. Poor body image is called Body Dysmorphia and the need for changing your nose, lips or anything else is a symptom. Eating disorders is always about poor body image. It broke my heart to learn that Jesy starved for a week to look thinner on a show. Jesy – this will only make you crave food even more. Katie Hopkins, I rate some of your ideas – but calling Jesy a chub is a crime, for which I would willingly hang you out to dry or put you in the stocks. A 9-year-old child I know, who is as thin as a reed, was fat-shamed “for fun” online a month ago. I have something on this website information section about body image if you would like to read it. https://eating-disorders.org.uk/information/body-image/
And we can treat poor body image too. Is your body the real problem or your OPINIONS about your body? Do you need HELP with internet bullying? Don’t suffer in silence. Don’t wage war on your body. Ask for help. Call us 0845 838 2040 This is something we can treat .
Are you vegan because you love animals, or is it a way to lose weight? Do you feel deep deep down that vegan-eating will prevent weight gain? Do you feel dirty if you eat fish, meat or eggs? Have you ideas of saving the planet? If you do, learn how plant based diets contribute to affecting the biosphere. Its more complicated than you think.
Victoria Lambert writes in the Telegraph. “When I first went back to eating fish after a year of strict veganism, I noticed the effect quite fast. I felt more alert and aware as though someone had woken me up.
My experience replicated that of actor Anne Hathaway who said she felt like her brain had “rebooted” when she returned to eating fish after some years on a plant based diet.
Now a new report in the journal BMJ Nutrition, Prevention & Health suggests that our instinctive dietary changes may be grounded in fact. Dr Emma Derbyshire has warned that vegans may be storing up health problems for themselves and even future generations.
Dr Derbyshire is concerned that vegans cannot access the amino acid choline which is essential for the health and development of our brains.
“Plant-based diets are great and brilliant for the environment,” she says. “But in terms of reducing intake of choline – which is vital for foetal brain development – no-one had given it much thought.”
Choline is not the only nutrient a vegan diet can lack, says consultant dietitian Sophie Medlin, a lecturer in Nutrition and Dietetics at King’s College London.
“Anyone following a plant-based diet,” says Medlin, “is likely to have sub-optimal levels of Vitamin B12 and an essential fatty acid called DHA. These are vital for the health of our neurons or brain cells.”
Deficiency symptoms include brain fog, short-term memory loss, changes in mood, difficulty sleeping, agitation and anxiety.
Choline, DHA and B12 have one other thing in common: they cannot be made in the body and only accessed in meat, fish, algae or dairy directly.
Vegan supplements do exist: DHA can be found in an algae supplement and B12 via an oral spray. Choline is more complicated as it is only available as a powder to be added to food but supplies are unregulated and, says Medlin, its’ impossible to know how much you need to take.
For those of us who have taken veganism on as a dietary change hoping to feel better, Medlin suggests introducing a little meat or daily, via a glass of milk or a portion of oily fish.
However for those doing it for ethical reasons she says: “I’d like to see The Vegan Society getting more involved. They need to warn of the risks and signs of deficiency and how that can be overcome in a properly vegan way.
“Giving up being vegan is difficult if you are committed to animal welfare. So vegans need to be shown all the options to support them. But if they want to avoid brain fog, they need to know the risks that they are running of serious nutritional deficiency.”
A report came in about a young person going blind because of their eating difficulties. Today, I also had a phone call from the parent of a 5-year old autistic boy who will only eat crackers and is not getting the right help from his therapist.
So, let’s make it clear what ARFID is, what causes it,
and what to do about it.
ARFID is a name given to a cluster of eating difficulties. It means Avoidant Restrictive Eating Disorder.
It exists in children who are called fussy eaters and it exists in adults in
various forms. I (Deanne Jade) am an eating disorder specialist and I am a
Selective Eater, there are many foods I just don’t eat because of texture or
taste. But I eat well. You could call me an ARFID case, but I am healthy fit
and very well fed.
An eating disorder is SPECIFICALLY eating disturbances which are motivated by
the need to control weight and shape. Not all ARFID behaviours thus satisfy the
definition of being a classical eating disorder like anorexia or bulimia. ARFID
is a name given to a cluster of conditions which are different. These could include
ANOREXIA NERVOSA in a child. Children as young as 5 can get
anorexia. The diagnosis is only valid if the eating motivations are fear of
weight gain. Children with anorexia don’t usually complain of feeling fat; they
are more likely to complain of tummy aches. It takes a specialist to tease out
the weight control issues that are affecting their desire to eat.
SELECTIVE EATING – where a child will only eat bread and jam
or crackers. Selective eating is normal in children due to something we call
neophobia (fear of eating what is unfamiliar). It can be very dangerous or mild
and often changes as a child ages. The REASONS are very diverse. Some children
might have early traumatic experiences with choking, swallowing difficulties if
given food lumps too soon fear of being sick which they associate with certain
foods, or they just haven’t been well trained in eating a wide variety of
foods. It is easier for a child to eat a wide variety of foods if their mother
has eaten widely and well during pregnancy and breast feeding.
Selective eating can emerge due to unhelpful parenting,
family poverty where parents only give children food they will eat. They cannot
afford to buy vegetables and have them discarded. Parents who want their child to eat often don’t
know how to persuade their child to try something they dislike and give up too
easily or use the wrong skills such as shouting or bribery which often doesn’t work.
SELECTIVE EATING OR ANOREXIA – AUTISM
Arfid behaviours are common in autistic people of all ages; autistics typically have a narrow range of foods they feel able to eat. They may avoid certain colours, only eating yellow food, and commonly experience panic if they are asked to eat anything unfamiliar. The primary problems in autism include what psychologists call “central coherence”- this means problems with how the brain is wired. Wiring is not an illness but it can help make people ill; they find it hard to shift out of persistent unhelpful behaviour. Another primary problem in people living with neuro-divergence is sensory hypersensitivity that makes certain textures hard to bear.
ORTHOREXIA could be viewed as a form of ARFID. Orthorexia is
where people restrict the types of food that they are willing to eat because they
think it is bad for them. They may for various
reasons start to cut out meat, dairy food, wheat, all carbohydrate because they
have developed fixations that such eating is wrong, or they are allergic.
Orthorexia is associated with anxiety and in some people orthorexia is linked
to weight control, being just another
way of being on a diet. Orthorexia in those cases is a classical eating disorder
not unlike anorexia. It is a problem when it interferes with life and general
happiness. Orthorexia is explained more fully elsewhere on our website.
CHILDHOOD FOOD AVOIDANCE EMOTIONAL DISORDER is not anorexia;
it is a stress response, sometimes to drama or adverse experiences during
childhood. It is more common in sensitive children. We cannot make assumptions
about whether the problem is in the family or in the personality of a child or
their environment. A careful assessment must be made.
PERVASIVE REFUSAL to eat is present when a child is unable
to take care of themselves in any way and is often the effect of trauma and
abuse.
OTHER CAUSES OF ARFID
Restrictive eating can exist in people with other mental
health difficulties like schizophrenia where for example, people have delusions
about food in general or certain types of food. Delusions of being poisoned can
lead some mentally fragile people to avoid eating.
WHAT TO DO ABOUT IT: CHILDREN
Since ARFID takes many forms, the first thing to do with a child
is to see a GP, to express your concerns. A GP should track a child’s weight
and growth to make sure that they continue to thrive. A GP can see if there are
physical problems; it would be wrong to assume that the eating is entirely
emotional.
There are things that parents can do at home. Children don’t
respond well to bribery or threats. If parents regularly give pea-size portions
of disliked food and gently insist that these are eaten, over time (keep going)
the child will learn to accept and tolerate new tastes. Thee should be no
attempts to fill up with foods high in sugar, like cakes and biscuits, although
parents are rightly afraid that their child is not getting enough. If you are very worried, find a way to supplement
a meagre diet with appropriate vitamins and an omega 3 supplement which is
important for brain health.
Getting a child to cook with / for the family is a useful
way to broaden their familiarity with new foods. You can do this with a child
as young as 4 or 5 starting with things that are easy like making a smoothie
(healthy) which contains a range of fruits and vegetables. We recently made
carrot ice cream which our children loved.
Children live what they learn, so they will watch what their
parents eat (show enthusiasm about healthful foods). It may be helpful to learn
skills to hide vegetables in food, or use other tricks to ensure a child eats a
less
diet. Some children grow out of ARFID, but not all.
IF THE SITUATION IS WORRYING
If a GP is worried, the next step would be to ask for an
appointment with a child psychologist who will do a proper emotional risk
assessment, to find out what KIND of ARFID is present. The psychologist should be able to advise on
strategies to help a child eat better. CBT is useful to deal with some forms of ARFID
but this is mostly for adolescents and adults.
If you have concerns about inadequate help, please call us
for some advice. We have some therapists who are qualified to work with
children. Call 0845 838 2040 and speak
to someone who cares.
All of us here at the office are inundated with Anorexia Blogs, posts and stories. We welcome your writing in hope to treat anorexia, and we know that writing about anorexia helps you if you are suffering.
This is an account of Anorexia written by Lizzie Porter. It is Eating Disorder Awareness time again and we wonder if what you are writing helps others, or helps them to reach out.
We get very sad reading all this ourselves. But it is OK if this helps us to treat anorexia or if this helps you to recover. Or if it adds to our awareness and understanding of the disease.
I do not think that any descriptions aid understanding because people with anorexia do not really understand themselves; they just describe in a lot of very colourful detail. A starving being is stripped of self awareness. It is up to us psychotherapists to know about the nature of the Voice and to know what else is hidden underneath this condition. It is the hidden material which is not in awareness.
I have talked today to a journalist about pro anorexia websites and what is bad and good about them. I explained about anorexia and what it means if you have it. It isn’t just a wish to be thin and you can’t treat it with threats and promises. It is like Aids of the soul.
If reading Lizzie’s article helps you, along with all the other books and stories, then we will keep on sharing your stories. Please, please, please, please, however send us more stories about what helped you to recover. Please use your suffering to help others recover, if you can. I recovered from anorexia many years ago and it is simply a shadow memory. I do not give it house room any more. The wish to be thin never goes away, but the Voice now bounces off a different life for which I am always grateful.
