But in some ways, the most significant choices one makes in life are done for reasons that are not all that dramatic, not earth-shaking at all; often enough, the choices we make are, for better or for worse, made by default.

It is not a sudden leap from sick to well. It is a slow, strange meander from sick to mostly well. The misconception that eating disorders are a medical disease in the traditional sense is not helpful here. There is no 'cure'. A pill will not fix it, though it may help. Ditto therapy, ditto food, ditto endless support from family and friends. You fix it yourself. It is the hardest thing that I have ever done, and I found myself stronger for doing it. Much stronger.

Because I'm not, in fact, depressed, Prozac makes me manic and numb - one of the reasons I slice my arm in the first place is that I'm coked to the gills on something utterly wrong for what I have.

In that six months, so much happened that death seemed, primarily, inconvenient. The trial period was extended. I seem to keep extending it. There are many things to do. There are books to write and naps to take. There are movies to see and scrambled eggs to eat. Life is essentially trivial. You either decide you will take the trite business of life and give yourself the option of doing something really cool, or you decide you will opt for the Grand Epic of eating disorders and dedicate your life to being seriously trivial.

The term “starvation diet” refers to 900 calories a day. I was on one-third of a starvation diet. What do you call that? One word that comes to my mind: “suicide.

You wake up one morning and there it is, sitting in an old plaid bathrobe in your kitchen, unpleasant and unshaved. You look at it, heart sinking. Madness is a rotten guest.

• Eating disorders are addictions. You become addicted to a number of their effects. The two most basic and important: the pure adrenaline that kicks in when you're starving—you're high as a kite, sleepless, full of a frenetic, unstable energy—and the heightened intensity of experience that eating disorders initially induce. At first, everything tastes and smells intense, tactile experience is intense, your own drive and energy themselves are intense and focused. Your sense of power is very, very intense. You are not aware, however, that you are quickly becoming addicted.