I have been wanting to write about my thoughts on this topic for years now. I have just been too reluctant for many reasons, mostly neurotic ones – “No one will read it”, “No one will care”, “There are so many amazing thinkers and writers out there, how can I make a difference?” These ideas were sitting in my mind, brewing, without direction and I was lacking the confidence to move them from my inner voice to paper. But like so many things in life, this self-hindering process changed in a moment. I have a client, let’s call her Michelle, who recently finished a year of treatment with me. She came in as a “chronic” anorexic – a history of 14 years of the illness- and went through my intensive program in which her husband helped to re-feed her until she was able to eat normally on her own (yes, you read that right, her husband was instrumental in supervising her eating while she was sick). It is now a year later and she is for the most part anorexic free. She exercises and eats on her own, accepts her body where it is even if she doesn’t love it, is no longer feeling trapped or depressed, and is fully empowered to step into her life. One day, we were talking about her recovery and she declared emphatically “I don’t want to be in recovery from anorexia, I want to be fully recovered!”
It was a powerful moment, a true shift in her self-perception and clearly it impacted me as well. I had never had a patient clarify things for me like this. But, this statement summarized so beautifully all of the work I had been doing with her so far. Everything I had said, done, implied, wished, and hoped for when it came to her and all my other patients. I didn’t want them to be on an alternate path of the anorexia titled “I am in recovery”. I wanted them done with it, finished with it, competely and totally. Full Recovery. It is what I had been taught as a young psychologist to never hope for when it came to these patients. I would hear “Ellen, these patients never really get better, they just learn to manage their illness”. Or, “Ellen, this is the hardest mental illness to treat with the highest mortality rate, don’t kid yourself that you can actually cure it”. So, I admit for the first part of my career, I, like many patients never peeked beyond the partition that separates this partially recovered state from true complete healing. This lack of truly getting better was something I had come to accept as part of working in this specialized field.
But everything changed about twelve years ago when I shifted radically from my more psychodynamic thoughts on anorexia to a family based and behavioral paradigm (much more about this transition later…..). Long story short, for the first time, not only did the patients respond quite rapidly to this change in intervention but when treatment was over, they were done with the illness. I mean DONE. I don’t mean acting “as if” they were done or hoping they were done but just plain done. I began to say in my sessions “The anorexia has left the building” and the loved ones and patients would nod their heads in agreement but quickly shake their heads in disbelief as to “how this could have happened” as they were told their loved ones would “never really get better”.
So, my goals for this blog are twofold so far – 1-to not have it run too long (which I already am at risk for not achieving), and 2- to highlight for you the reader my thinking as to what leads to the ultimate outcome of true recovery. Why have I named it the 10 pound blog? Again, without getting into all of my thoughts right away, I am now, after 12 years, utterly and totally convinced that the difference between many patients being in a partially recovered vs. fully recovered state is just that – about 10 pounds. Yes, some need more, but most don’t. This was also a surprise to me. I was sure that these “sick” patients would need to gain much more (and to them 10 pounds feels like 100) but objectively, I was shocked that time and time again they were simply walking around 10 pounds under their full goal weight. As soon as these patients were pushed to gained this weight, I saw a significant shift in their thinking – the disease receded – and the veil was lifted that revealed true recovery.
A key phrase you may have noticed above is “the patient was pushed” to gain weight. This speaks to my allegiance to conceptualizing anorexia as a brain based illness which needs to be actively treated with its medicine – food. I used to be of a very different ilk – I used to think that “pushing” a patient to eat was disrespectful and invalidating of the person. I used to wait and wait (…..and wait and wait and wait and wait)… until the patient herself declared that they were ready to eat on their own (if this even ever happened). I am now very clear that this pushing to eat is an invalidation of the disease which has overtaken the person. The patient needs help, even when the disease won’t let them ask for any help.
I hope in some small way the wisdom that is shared here from me and sometimes gleaned from my patients or other colleagues will be a small influence in even one patient’s quest for full recovery. I would like to reassure even one person that full recovery is not a mirage. It can truly be reached through the influence of an informed, compassionate treatment team.