The Process of Recovery from an Eating Disorder

Recovery from an eating disorder is a process. For people who see the world in very black-and-white terms, namely those with eating disorders, the concept of process is a tall order. It implies ups and downs, swings that feel very powerful emotionally and days when all seems for nought. Years of an eating disorder wear down even the preternaturally hopeful and binds any optimism into a vortex of doom. In such a dramatic place the whole idea of process appears incredibly naive.

But the process of recovery is what we clinicians have to offer. Put simply, simple tools practiced over time really do work. Write a food journal every day; plan your meals the night before; be active during the day, especially after meals; be around people, even when you want to be alone; and pay attention to your feelings for they are the best clues to stay on the path to recovery.

When the person in recovery knows that her therapist and treatment team are willing to go through that process too, she knows she's not alone. That makes all the difference in the world. 

The concept of process implies another necessary component in recovery: resilience. The path of an eating disorder typically leaves people feeling completely powerless. The best laid plans falter from the get go. A day derailed early never gets back on track. The mantra of the person with an eating disorder is "I'll start towards recovery tomorrow," but tomorrow never comes. It's a new idea to contemplate resilience in the face of the eating disorder commands. That simple suggestions and support can alter the eating disorder symptoms feels miraculous. It feels impossible for a day to start off challenging and turn out all right. Yet experiencing resilience revitalizes true belief in hope again. 

Once process and resilience become real to the person in recovery, she begins to experience something very new and raw. The despair connected with the lost time of an eating disorder and the numbing effect of the symptoms both limit any knowledge of the true emotional experience of daily life.

Regular people learn to cope with their own emotions through years of practice. They come to know themselves and how they can live with their feelings, some constructively and some less so. A person in recovery is suddenly thrust into a world of raw, intense emotions, ones she hasn't experienced in a long time. Even a crash course in personal exploration doesn't prepare her for the jarring blast of the panoply of emotions: sadness, anger, disappointment, shame, frustration and fear. The pull to use eating disorder symptoms and return to numbness is very strong, a salve for all the open wounds, but one that only leads back to despair.

When it comes to the emotional life of recovery, each person needs to understand the process too. Time will heal those wounds. Emotions may feel like a bottomless pit, but the bottom comes before you know it. Emotions for someone in recovery are, in the end, the same as everyone else's. It just takes time to get used to them. The simple things people do in order to weather emotions works for those in recovery: talk to someone, journal, watch a movie or just cry. These tools seem inadequate, perhaps even trivializing, at first, but emotions are just a part of life, a reality of being human. No powerful intellect or personal mastery allows anyone a pass on feelings. The mastery is akin to acceptance: the process of succumbing to emotions in the moment, even of you're unsure of the path ahead, is bearable when you remember you'll be all right in the end. 

This last step points out one more step in the process, trust. A person in recovery doesn't know how to trust their own instincts or ability to make reasonable decisions each day, let alone trust anyone else to guide them. The eating disorder has been the only guide in life. Yet believing in hope, resilience and emotions requires trust in oneself, clinicians and family. This is not a path one can forge alone.

The ups and downs, moments of elation or panic and feelings of hopelessness and despair will be unbearable for a person completely alone. People to share these experiences with and shoulders to cry on will mitigate what feels insurmountable. That support enables the person with an eating disorder to work just as hard the next day until recovery starts to feel like it's paying off. Given the necessary time, the process of recovery works. People sick with eating disorders do get well. 

"Fat Talk:" the Startling Column in The New York Times

It was surprising to see a health column in the New York Times about the risks of women engaging in "fat talk." For years this weekly section has been a soapbox for over-exercising and supposed healthy eating, and, in the journalist Jane Brody’s column, the weekly standard of the section, at times leaning even towards unethical. The increasing attention to topics such as treatment of chronic running injuries in middle age has been worrisome. But perhaps the growing media shift away from body and weight finally caught the paper’s eye. 

The article raises awareness and provides evidence for the risks of women who bond over body and weight concerns. The desire for connectedness among women, unsurprisingly in today's world, often includes discussion of weight and body obsession, the current defining piece of a woman's identity. This "fat talk," as the article points out, only worsens a woman's self-image and confidence by validating weight and body as central to a woman's self-worth. The take-away message is clear: fat talk has to go.

The news in the article isn't the headline but the paper it appears in. It's truly notable that a newspaper that touts a journalist like Jane Brody would make this shift on women and body image. The article also presents a true problem for women today: how can "fat talk" become taboo?

As a clinician treating people with eating disorders, I believe a larger transformation in women’s thinking would ease treatment greatly. And if a journalist like Jane Brody could be convinced that food and body, under the guise of better health, aren't the only virtues to aspire to, there is hope for the community at large.

One recurrent disagreement for people in recovery is whether women's behavior and beliefs about food and weight just normalizes eating disordered thinking. Many women with eating disorders feel like everyone is concerned with weight so why are they so different. Clinicians try to point out how personally destructive eating disorders are but can be thwarted by the media attention to food and weight. Until now, columns like Jane Brody's certainly don't make it any easier. If a woman so distorted in her thinking about food and weight can write for the Times, then patients feel justified to hang onto many eating disorder beliefs as normal, healthy thoughts.

True recovery from an eating disorder or freedom from the tyranny of disordered, obsessive eating needs a real transformation in thought process. Just altering eating habits and exercise without ending the waste of mental and emotional energy on the pursuit of a diet or body shape is ineffective and pointless. But it's a hard sell to women to reevaluate their self-image and satisfaction and consider other criteria. It's one thing to help someone recover and another to ask them to be a pioneer in a new world where women are free from the constant scrutiny of shape and weight.

Perhaps this is only the first step in this column’s transformation. It's significant for the paper to recognize and write about the dangers of fat talk. One hopes the editorial staff realizes that years of articles displaying public obsession with running and food could bolster many women's distorted thinking and behavior. One article that implies there must be an alternate way women can connect is important but only the beginning of a more complete message I hope the paper can embrace.

That's the step this column has yet to take. For a woman like Jane Brody, whose identity centers on eating disordered activities and as the major health writer at the Times, she faces a monumental task to reassess her sense of herself and acknowledge the time lost to a fruitless goal. Some attention to food choice and regular exercise clearly has benefits, but the limited evidence points to the obvious: don't subsist on fast food and don't sit on the couch all day. The rest, a large part of her years of work, is myth and hearsay.

A much braver step for such a respected science and health newspaper section would be to question the value of spending so much time and energy on dietary choice and exercise. For a paper with such a platform, the story of a personal transformation could model a change in philosophy unknown in any public domain. The behavior of this longstanding journalist has outwitted the Times' editorial staff for many years. However, the process of a public, personal awakening to her own struggle with fat talk and fat thoughts, even behind the facade of a science writer, would have a significant impact in these changing times.