I thought I would share a treatment story that a listener to the Eating Disorder Recovery Podcast sent me recently.
I am writing you in reply to your podcast on eating disorder treatment failures and your question to share experiences as an adult having been to a recovery clinic. Having had anorexia from 15 years old and still, as a 23-year-old, struggling with it, I have been to a recovery clinic last year, after which I soon moved from Belgium to Sweden to work as a PhD-student in literature (my greatest motivation to enrol in a treatment program to begin with).
Though I got along with eating pretty okay the first two months, a stomach flu caused my doctor to prescribe me a diet of a significantly small amount of white toasted bread for a week, which, in result, caused me to spiral into a relapse, and now, 1,5 month later, I have lost almost all the weight I had been able to put on this last year, my body, which had been tolerating my self-imposed starvation for so long with unbelievable strength, now almost immediately shut down, and the restrictions, obsessions and compulsions are stronger than ever. Hearing that a significant amount of people during my in-patient treatment are going through a similar relapse, I became intensely frustrated at why so many of these patients are seemingly no step farther (mentally, that is) than they were before entering the clinic, so I took a digital plunge and ended up with your Youtube videos. Never having experienced such a view on recovery before, I became increasingly fascinated by your own experiences and approach, and I consumed your two books in about a day (talk about a feast, huh), and, the process of recovery for the first time seeming to be something I can do, I happily embarked on my own re-recovery process now. Moreover, your insights led me not only to apprehend that the energy deficit due to the stomach flu-diet seems to be the main trigger of my relapse, but, more importantly, that I may have never been in recovery at all, despite being in-patient in a recovery clinic. As I said, I am from Belgium, and I don’t know if you’re mainly focusing on American treatments, but perhaps some of my experiences may add to a broader picture of treatment failures.
I think that the best way to describe is to say that it operated, in all aspects, with a BMI scale. There were different rules, concerning for instance movement within and in the gardens of the clinic and going home in the weekend/to town, according to which range your BMI fell in (below 12, 12-14, 14-16, 16-19) with 19 as the goal BMI. Unfortunately, these rules also crept in the rules of the dietician there. There were meal plans of 2000 calories for people from BMI 18 onwards, 2500 if you had to gain weight, and 3000 if your BMI was under 16 – people with a BMI of over 25 were given reduced meal plans of 1800 cal. We were forbidden to go beyond the meal plans, which functioned as our Bibles.
Before I got anorexia, my BMI always hovered between 24-25 (and it was the doctor’s concern of this number which propelled me into my first diet – the onset of anorexia), and, despite becoming horribly emaciated, my BMI never sunk under 18.5. With the meal plan of 2000 calories, I reached BMI 19 within 2 weeks, and, despite it being perspicuously visible that I was sick as hell (excuse my language) and being severely starved (having been living on coffee and two apples a week for the last 4 months), they decided that this meal plan was ideal for me (on top of that, in my first week they told me I could start exercising again, which I questioned myself as I had a severe exercise compulsion (walking 25 km and doing an hour of HIIT every single day for the last year – they found my reaction very strange, because of my history with being overweight). I got hungry, really, really hungry. In fact, I have never been so hungry, not even when living on those apples. But I had to stick to the meal plan – the meal plan was holy (one time, a girl reported she had skipped a meal during the weekend and out of hunger and guilt had eaten more during the day and she was severely reprimanded). I wouldn’t want to go back to where I came from, did I? After weeks of complaining of my hunger to the dietician (which, as you can imagine for someone recovering from anorexia in a clinic in which your lowest weight is embraced as the goal weight of a recovered person), I was allowed to add two extra slices of bread during the day. It did not help.
Now, turns out that everyone on the 2000 calorie mealplan was hungry, because the meals (which were already ridiculously bland, how could you expect someone to enjoy food again when the food is just bad?) were of a portion which could fit ideally in a Weight Watchers diet. They were comically small. On our ‘difficult day’, for example, we were served fries. I counted them. Ten. We got ten fries. Fries being one of my (and almost everyone’s) greatest fear foods, this completely convinced my idea about fried foods. They could only be dealt with with severe restriction – something which leaves me, up to this day, unable to put fries on my plate because I can’t handle the number (fries were my favourite food before I got anorexia, and then ten was about the number I ate as an appetizer on my way back when I went to order the fries before sitting down for dinner). Anyway, we, as a recovery clinic, were part of a greater psychiatric clinic, and on some days we were to eat in the cafetaria among other patients. On one of these fries-days I noticed that these other patients got almost triple the amount of fries that we were served, and this led me to study their plates, which were, every meal, double the portion we, patients restoring their weight, were served. Enough with the fries. Anyway, the hunger led one of the women to binge in the night (though they always locked the fridges and food storages, she managed to find a way in). After two of those episodes, she was sent away from the clinic, but not before being publicly scolded by the dietician and the head of the clinic. It broke my heart.
Binges were demonized by the dietician. Actually, when you told you had deviated from the meal plan in the weekends (when you were home), you were reprimanded for starting to develop BED – for instance, one weekend I told I had bravely added a pancake to my 3 slices of bread, I was told it was getting out of hand. To cut a long story at least a bit shorter, after 4 months I left the clinic with a BMI having gone up 2 points, more hungry than ever, but with the dictum of ‘never add anything to the meal plan, never listen to hunger or you’ll develop BED and that is bad’. Writing it down this way, I now come to the conclusion that I cannot even speak of a current relapse because I have never gotten out of the restricted eating. Up until now, and I’m only starting this approach from this week, but for the first time I feel that recovery can actually be something hopeful rather than depressing.