Today I am participating in Mental Health Monday hosted by the lovely Julia over at Drops of Jules – check it out!
Eating disorder recovery is hard. In fact, it is among the most difficult things I have ever done (and continue to do). It is made more difficult for those in recovery by one of the biggest misconceptions about eating disorders, particularly anorexia; that they are physical illnesses. Even for individuals who have eating disorders, perhaps more so, it can be incredibly difficult to escape the view of anorexia and other eating disorders as diseases of the body rather than of the mind. Let me be entirely clear here they are mental illnesses, not physical illnesses. However, they do have physical symptoms. The mistake here is the conflation of symptoms of illness and illness. This is a phenomenon that occurs with many illnesses. For example, when cold season comes around people might say they have a cough or a sore throat to explain what is wrong when what they are actually describing (and know full well that they are doing so) is the symptom of a viral infection. This is a perfectly valid and socially normal shorthand. However, when we’re talking eating disorders, the confusion between symptom and illness becomes potentially devastating.
Many people with eating disorders, myself included, are pushed into recovery with the highly disordered notion that they are “not sick enough” or “not skinny enough” to have and eating disorder or to recover. This comes straight from the belief that the physical and visible symptoms of an eating disorder are the eating disorder. This belief system is so dangerous because it is precisely what fuels the fire. The perception that a person must look emaciated or be underweight in order to have an eating disorder obviously leads to more restriction and potentially more weight loss, binging, purging, over-exercising and other highly damaging behaviours. Anyone who has ever experience this will know, however, that there is never going to be a point at which you will be “sick enough” or “skinny enough” in your own mind to seek help and get better. Might I point out that healthy people do not want to be sick. That is not okay or normal in any way and it should be setting off alarm bells immediately regardless of a person’s weight.
This is only worsened by a society that makes the assumption that one must be displaying physical symptoms to have an eating disorder. Even medical professionals are not immune to this problematic view. What is a person to do if they themselves do not feel they have an eating disorder and those around them cannot ‘see’ it? In many cases, as in the story linked above, people have to reach a very low weight and be physically ill for anyone to intervene. Trust me when I say that the lasting damage of an eating disorder can and often does occur long before a person displays physical symptoms. Most sufferers display little to no physical symptoms at all even when they are mentally very, very sick. Imagine having a broken arm and being told you must not be that injured because your bone isn’t sticking out. For the eating disordered mind, this is the worst possible response because, as with self-denial, it provides permission to continue with dangerous behaviours and denies the damage a person is doing to themselves.
Another major issue with the conflation of symptom and illness occurs when a person becomes physically well after experiencing anorexia. The other side of the assumption that a person must be underweight in order to be suffering from an eating disorder is the belief that weight restoration is recovery. By the logic that an eating disorder is a physical problem, the problem is solved when the physical symptom is no longer present. Guess what? It’s not. Recovery of physical damage is absolutely necessary and should be the first step in eating disorder recovery, but it is only the beginning of the process. It is more or less categorically accepted by those who work in eating disorder treatment that a patient must achieve physical health before it is possible for a full recovery to take place. However, the return of physical health is often viewed by those who have not experienced eating disorders or recovery (and sometimes even those who have) as signifying a recovery. Don’t get me wrong, it is a HUGE step in the right direction but it is usually just the start of returning to a normal life. After weight restoration, many of the disordered thought patterns will still be very dominant and a person’s life may still be deeply affected by their eating disorder. I would guess that this is the main reason for such high rates of relapse in eating disorder patients. As soon as the weight goes up, the guard goes down and even in the most recovered individual behaviours can then start to seep in. Before you know it you’re eating disorder is gaining control again. Quasi-recovery can also occur because of this. A person reaches a ‘healthy weight’ and begins restricting to maintain a weight at the very low end of the healthy range (let’s assume we’re working on BMI here). Whether or not that is healthy for the individual is another story altogether. A person can live like that for a lifetime in a society where thinness is desirable.
In recovery from an eating disorder, the paramount thing to remember is that a person does not have a physical disease. In order for them to get better, it is the cause that must be treated. Don’t let a flawed and reductionist view of eating disorders make you believe otherwise. Don’t let an eating disorder make you believe otherwise. Figure out what purpose the eating disorder serves and you will find what you need to really get better.