In our series “On the Table,” we explore the various ways eating disorders and body image-related issues can impact a person in daily life, through the lens of one young woman who has experienced these struggles firsthand.
Eating disorders affect over 30 million Americans. But despite being treatable illnesses, less than 60 percent of people with eating disorders recover. But what does it mean to fully recover, and is it really possible? It depends on who you ask.
With alcoholism and drug addiction, it’s widely believed that the recovery process is lifelong. I can’t speak to this personally, as I’ve (thankfully) never struggled with substance abuse, but I have battled an eating disorder of varying levels of severity for the past 16 years. And with eating disorders, there’s been an ongoing debate on whether a person can recover fully, or will be in recovery for his or her whole life.
How is recovering from an eating disorder different from someone with alcoholism who is thought to be in recovery for their entire life?
I’ve witnessed this idea of full recovery through friends and peers I’ve met in treatment and in the recovery community. Something I’ve always struggled with, though, is that not only does “full recovery” look different for everyone, but also that even in a case of full recovery, that person must generally still abstain from dieting, certain forms of exercise, getting on a scale, and more, in order to stay recovered.
While these behaviors may not be healthy or necessary even for someone without a history of an eating disorder, I wonder how it’s different from someone with alcoholism who must abstain from alcohol and their own set of triggers, and subsequently is thought to be in recovery for his or her entire life.
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As for the definition of full recovery, Carolyn Costin, one of the most renowned eating disorder therapists in the country, defines it as the following: “Being recovered, to me, is when the person can accept his or her natural body size and shape and no longer has a self-destructive or unnatural relationship with food or exercise.” Costin recovered from her own eating disorder 40 years ago and is firm in her belief that full recovery is possible even in the most severe or chronic cases.
“By far, I think the reason many do not get better is because they give up on the system, or worse, give up on themselves.”
“I have treated people who had an eating disorder for 40 years, who are recovered today. I have treated people who had up to 20 previous hospitalizations, and everyone had given up on them, who are recovered today,” she said. “The belief that one will not have an eating disorder for life and can be ‘recovered’ is a very important issue. How a treating professional views the illness and the treatment will not only affect the nature of the treatment but also the actual outcome itself.”
So, then, why do some people recover and some don’t? “Some people don’t have the resources to get the help they need, some deny they need help, and some have had the eating disorder for so long and need long-term care that is far too expensive for them to afford,” says Costin. “Some have co-morbid conditions that make treatment harder. But by far, I think the reason many do not get better is because they give up–they give up on the system, or worse, they give up on themselves.”
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Liana Rosenman and Kristina Saffran met in treatment as teenagers and founded their non-profit, Project HEAL, for this very reason. Treatment for an eating disorder can cost upwards of $30,000 a month, an expense that most Americans simply cannot afford, and one that insurance often won’t cover. Both Rosenman and Saffran have been fully recovered for several years now, and generally share Costin’s outlook on recovery.
“A lot of people think you can’t fully recover from an eating disorder—that you’ll always be in a state of ‘recovery’ because recovery is a process, not a destination,” says Rosenman. “However, I believe in full recovery. I no longer see the world through the lens of appearance, weight, and food. I see and value myself as a person with strengths and gifts. I will be honest, though, and say that I will always be a recovering perfectionist.”
I no longer see the world through the lens of appearance, weight, and food… but I will always be a recovering perfectionist.
Saffran agrees, saying, “I believe strongly in full recovery. I eat what I want, when I want, and my self-worth is no longer comprised of my weight or body. That said, relapse is a real concern in this field and should not be taken lightly, and there are certain things that might put me in a vulnerable position that I will never do: own a scale, go on a diet, or train for a marathon.”
Since I’m still actively working on my own recovery, I asked Saffran how she handles the clash between considering herself recovered, but still having to be mindful of situations that might make her vulnerable—like an alcoholic avoiding situations involving drinking altogether, and being in recovery for a lifetime.
“I don’t know that it’s a fair comparison,” she told me. “Drinking in moderation has benefits. Dieting and owning a scale have none. A marathon is probably a better comparison–I run, but would never train for a marathon. And actually, I have a similar relationship with the scale. I’ll get on one at the doctor’s office, but have no need to have it in my house.”
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Costin says that comparing an eating disorder to an addiction like alcoholism can also be problematic in its implications for recovery. She thinks that in some ways, subscribing to the a 12-step approach while recovering from an eating disorder can turn into a self-fulfilling prophecy. In other words, if someone doesn’t believe that full recovery is possible or that they’ll always struggle to some extent, then reaching a recovered state is far less likely.
“Drug addicts and alcoholics don’t have to learn how to control the consumption of drugs or alcohol,” says Costin. “Abstinence from these substances can be a black and white issue and, in fact, is supposed to be. Addicts and alcoholics can give up drugs and alcohol completely and forever. A person with an eating disorder has to deal with food every day.”
“Addicts can give up drugs and alcohol completely, forever. A person with an eating disorder has to deal with food every day.”
In other words, a person with an eating disorder must eventually make peace with food in one way or another. That’s something that I, personally, am still working to do. And I do believe—not simply hope—that I can get there.
As author Marya Hornbacher wrote in her afterward for Wasted: A Memoir of Anorexia and Bulimia, “Hope is not a strategy,” because, unfortunately, one of the many things that makes recovery so difficult is that nobody is passively healed. As Hornbacher said, “Healing, above all, requires action.”
A version of this article originally appeared in October 2017.
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