How long will it take to recover?
The very anxious mind looks for certainty desperately and numbers, with their finite tangibility, offer this.
“Lose 5 pounds in 3 hours, walk 5 kms to work off 300 calories, there are 200 calories in 30 eggs”……………… yes, of course, I made up some ridiculous numbers. The truth I discovered recently, while talking to a client was that after 15 years of working in the Eating Disorder field, I do not actually know how many calories there are in an egg. Not because I am not a smart person but primarily because in my business of supporting recovery, that information is not of any value and it has only held my clients back. “How long will it take to recover?” also comes from this same tired, desperate place.
How many calories are there REALLY in an egg - I think the real answer would be “ it depends”. And that would be the answer to how long it takes to recover - it really depends.
When I refer to “recovery” I am not talking about a ‘partial, living on the edge’ state where I am living in eternal vigilance of weight gain and rejection of my self, a world of secret calculations that still subscribes to a reward system of right and wrong, good and bad. Sometimes so habitual and so secret that even the person does not realize how operative it is.
In my experience, the wishy washy conversation about the possibility of recovery in the minds of professionals has led many clients to believe that “true recovery” or true freedom from the circular thinking of an ED is not possible and at best one can only achieve a partial balance. The trouble with this ‘balance’ is that it is heavily weighted in favour of the ED. Anybody with an ED knows that it is not a benign illness that holds your hand and sits on a bench beside you. The ED behaviours are the symptoms of the person’s anxiety and it is the nature of anxiety to grow and fill the space it is allowed. So , an ED, in tiny parts , will grow back, like a dormant tumour, like a cactus when the time is right - when a relationship ends, when I lose a job, when I am in a difficult transition.
That Einstein quote - “Problems cannot be solved with the same mind set that created them.” It is hard to imagine recovery from the very unwell, anxious , rigid mindset of an ED. And therefore, it becomes imperative that one has to find a therapist and dietitian one can build trust with and borrow their imagination. And their guidance. In my mind, this is probably the most important contribution of the therapeutic process - the establishment of the possibility that a full, sustainable recovery is possible. And then following the steps , however scary they might be. The treatment team meets you where you are - and then helps your movement forward , one step at a time. I have heard many a client say - “I will do this on my own”. This idea comes from the same isolated place that fuels the maintenance of the ED. The issue is not the ED behaviours, the real issue is the idea that I can get out of my predicament holding onto my isolation, my self-criticism, my isolation and my illusion of control. I also know that many, many people hope that they can somehow figure out the solution without the support of a dietitian. This is simply more of the same. Talking to a knowledgeable dietitian about food fears and coming to see the dietitian as a resource and an ally is a game-changer. Through the repetitive process of diligently attending therapeutic sessions with both the therapist and a trusted dietitian , the person learns to start leaning on people rather than the familiar, closeted behaviours that lead to nothing but more isolation.
One also learns that “control” based on a precarious balance maintained by holding one’s breath is not really control at all. It is, rather, desperation in a very tight circle that simply keeps one preoccupied enough to mistake it for safety. One stands on a razor’s edge worried that a breath will topple the balance at any moment that the vigilance goes down. Such eternal vigilance is exhausting and bound to crumble over and over. The human body and Life are fluid entities. Life is a series of moving waves - the image and agility of a surfer comes to mind. In fact, emotions rise and fall as waves do in our body. When a person has not had the experience of an emotion being held - co-carried - with a trusted, calm adult in one’s youngest years when the body was too small for big emotions, these emotions become big scary experiences in the body. The amygdala is activated every time an emotion comes by and the “fight-flight” response is activated. It is like living in a house where the alarm is always ringing. The goal of therapy is to learn how to ride these waves of emotions with the support of a calm brain so that they can come and pass by as life goes on. A rigid surfer will fall off even before the water moves. Learning to tolerate emotions is a skill. Like all skills, it has to be learnt. And cultivated with practice. The good news is that it can be learnt.
Finally - the agreements in the mind - I realize that often what is not clearly articulated and talked about plays into the negoiations going on in the ED mind. So I say clearly that ALL behaviours have to be given up. I know ( and it has been verified for me by many many clients) that if this is not said there is an unspoken understanding that the person only has to relinquish the behaviours that are the most obvious or the ones that are named. Exercise and restriction are the two most often retained behaviours. And in my opinion, this partial relinquishing of behaviours keeps the underlying dynamic and connection with the ED going and it is certainly not “recovery”. The danger of this kind of partial management of symptoms is that when an emotional crisis happens in life, the ED is ready at the wings to take off. And the person says “My ED came back”. This situation contributes to the unhelpful narrative that Eating Disorders are “life-long” illnesses and that recovery is not possible. It also contributes to the general deflation that an ED client feels that they will never recover.
A word about “Motivation”.
Motivation is that feeling of eagerness, laced with excitement to do something. It is hard to feel motivated when a person is scared. The ED is the result of a person’s very desperate attempts to control their scary feelings. This person has no experience, yet, that they have the capacity to allow a feeling to pass by and feel alright , all at the same time. The grip on the ED is in direct proportion to the anxiety with or without trauma in the person’s life history. Almost all my clients come into treatment motivated, mostly, by the distress of the loved ones in their lives and rarely, out of the exhaustion of their wild calculating minds that will not stop. This is fine. Motivation for one’s own self will come , in tiny teaspoons , when the person in treatment encounters tiny successes that they never thought possible. The shift from “I will never……..” to wide-eyed “Oh , I think I can………..!” This motivation will gradually lead to more successes and the beginning of self-trust, self-esteem and self-worth. All in due time, one step by one step………
