What’s in a word - Remission, Relapse and Recovery?
The words we use affect the way we think.
In treatment, they also influence our methods and process. And a wrong word can take us in the wrong direction. There is no consensus in the eating disorder world about the possibility of recovery. Clinicians and clients alike differ on what they think. And therefore believe. Whether one thinks that a full recovery is possible decides the direction of one’s efforts and conversation from the very first meeting. The stage for the rest of the play is set very early. The client is curious about what the treatment team believes is possible and the power of suggestion is very alive. If the treatment team suggests that “statistics are not very good” and “Eating disorders are a life-long illness” and “you just have to learn to live with it” , I am doubtful that a client can find it in themselves to put in much effort.
Words and philosophies are borrowed from addiction treatment - “ You will always be an addict”. Or from cancer treatment - “remission”. Sadly, most often, what the treatment team believes becomes the foundation of the client’s mindset. Treatment is hard enough but if one is told that there is no way out of this labyrinth of numbers, it is hard to imagine what one would feel about all of life itself. In reality, eating disorders are not like cancer. One does have agency ( discovered and practised, with support) over changing one’s way of being in the world. If this were not so, none of us would learn anything new. The same brain cells that aid us in learning how to play piano or a new language also help us to change old habits. I am not suggesting that an ED is “just” an old habit. But in some ways, it is. When a person learns to take care of their emotions in other creative ways with constructive coping skills , the ED loses its function as a resource for scary and difficult emotions. And then, a person can do differently.
Words like “remission” are dangerous. Remission implies a merry-go-round that really leads back into itself, with no intention or hope of an exit. In my opinion, it simply describes what a person with an ED is already living with. The ED behaviours increase or decrease depending on the waves of anxiety and life events because other coping skills have not effectively replaced them yet. The treatment team and the client are simply bouncing around in the waves of life, like a helpless boat. It provides the client no motivation to consider closing the door on a behaviour with finality. The ED is the most effective and dependable coping skill the client has experienced thus far and the willingness to give it up, often wavers. The implication that we are just trying to “manage” the ED for the rest of a person’s life is a depressing life sentence that does not lend to much motivation.
Recovery is a meandering path with light at the end of it. And sustainable recovery does not include relapse. We hold space for “slips” as treatment proceeds. We hold space for the perfectionist to learn that making mistakes is alright and a part of life. There is a compass and a map. The journey is rocky and stormy, the waves are high and low but there is a lighthouse and a destination. And gradually the client learns to sail their boat and bring it to shore where they can live in peace with food and body in a way they never thought possible, before.
A clinician has to know this is possible and use the word “recovery” with confidence.
