On Saturday, February 25, our monthly support group meeting featured a recovery forum that consisted of individuals who have gone through the process of recovery. Bill, Lauren, Colleen, and Jordan answered questions and shared stories about their experiences. The topic of the meeting was: What is recovery, how do you get it, and how do you keep it?

First, we talked about the definition of recovery and what it means to different people. Generally, recovery is a process. Regarding Eating Disorders, it refers to the behavioral change that occurs within a person that enables him or her to understand what the ED does to them, to replace negative feelings with positive feelings, and to recognize that the change needs to be long-term.

The term “recovery” can also have a deeper meaning, especially to those who have gone through or are currently going through the process. To our recovery panel, “recovery” means…

“Accepting yourself and being happy with who you are.” – Bill

“Developing a new identity for yourself outside of your ED.” – Jordan

“At the end of the day, putting my win’s and loss’s down in separate columns and realizing that I am more in a state of recovery than I am in my ED.” – Colleen

“Being able to step out of my comfort zone without realizing it.” – Lauren

Dr. Erwin asked the panel to share how they got into recovery and when it began to work for them. These are their stories:

Bill was at Princeton for two weeks. Inpatient treatment helped him take that very critical first step towards recovery. Being there allowed him to reach the point where he was ready to face getting over ED. Bill stressed on how important that first step is, and that although it is the toughest, taking it is the only way to get to recovery.

Colleen was in an inpatient facility three different occasions. Although she felt she wasn’t ready the first and second time, the third time was a charm. After she was married, she sought treatment at Princeton. It was then she realized that she didn’t want to be a mom one day and have her kids deal with not being able to see her because she was in the hospital. “It was not about me anymore, it’s about my family now,” she said. Colleen considered each time in inpatient care as a success - not a failure - because she gained something from each time.

Lauren did not seek inpatient treatment; however, she reached a point of realization when she noticed how distraught her family had become over the effects of ED, and didn’t want to keep putting them through it. Looking back, she realized she closed herself off from her family and therapist. Now, she finds it easier to be open with them. Lauren stressed on how vital it is to understand that with recovery, you have to want it for yourself.

Jordan went to inpatient facilities several times. With each time, she learned new tricks. Initially, she did not want to give in to treatment; however, she realized how it helped her gain a new sense of self. “I found my voice again, figuratively and literally. I started to become this new person I really liked,” she said. The real challenge for her was after she got out of inpatient care. “I am getting better every day because I’m learning who I am more every day. I now have an identity that’s not a sick one,” said Jordan.

An important point brought up for concern was the dynamic of competition among patients in the ED units; for example, who can “drag out” their meals the longest at dinner. ED patients may also ask each other questions such as how many hospitalizations they have had or what their lowest weight was, etc. This competitive nature may come from the desire to want to know how “well” their ED worked for them, and they want others to know as well. Even more important than it is to be aware of this competition, is to recognize if/when it takes place and to remove yourself from the situation. Remind yourself that not playing those games makes you more of a winner than those who involve themselves in the competition.

Another fundamental topic discussed was physical health versus mental health, or more specifically, the idea that one has to become physically healthy in order to become mentally healthy. Inpatient treatment can provide the means of initial physical recovery that allows individuals to take the step towards mental recovery. Food stabilization has to come first, then physical recovery goes hand in hand with psychological counseling. Mental health follows physical health.

Bill, Colleen, Jordan, and Lauren are living examples that recovery is achievable. Take the first step like they have.

Excerpt from Journal 10-1-2011:

Additional thoughts:  As I was looking at this to share with you, I noticed that I did not refer to “ED” here at all and I believe that this became a conscious thing. I hear and I have even said… “ED” is speaking or “ED” is “Winning”…  I guess I just don’t really buy into that. I know, ED is a real medical sickness/ disease, however:  # 1:  I wonder if by naming it like a person we give it more of an identity, as if it is another person inside of us. I know we often feel that way and we want to cut out this piece of our consciousness that we call “ED” but also, by naming it and separating it from ourselves perhaps we are suggesting that we can’t control it and that it is separate from who we are. By giving it a separation and a name… do we give it power? When you separate “ED” from yourself and treat it like something out of our control, are you already allowing it to win?  And # 2… I believe that my “diseased thoughts” are bigger than just my issues that could be medically named as ED. For me, it’s about OCD, accepting self-love, and moving on from the fear towards acceptance. I have to wonder for those of us whom seek help with what we have named “ED- does our focus on the food, body, etc. both in and outside of therapy, take us away from the true roots of the problem?

Life is consciousness….

The ability to recognize a “diseased self” by separation of unhealthy and sick thoughts from more loving thoughts comes with a prevailing sense of fear, and the necessity to relinquish this fear seems absolutely essential for recovery.  The ability to be attuned with the consciousness of life, by embracing what is happening in the here-and-now, makes us accountable for actions and able to act out of love. In these moments of consciousness, we must confront our fears and push through them so that we can embrace the kind of life that we really want: a life without battle…a life without self-inflicted sickness... a life that affirms love and celebrates every moment.

 In my personal “combat” with my “diseased self,” I have longed for a  true acceptance of who I am. One thing is for sure, admission of my diseased thoughts and behaviors have marked the beginning of my process of usurping power from my eating disorder. I’ve begun accepting what is happening, good or bad… acknowledging that it is real, but then working to let it go. What other option is there? Sink deeper into destructive behaviors and give up on love and joy?? Although it seems easier to continue to act out of trepidation, by allowing destructive thoughts to turn into destructive actions, than to surrender and become accountable...this would be giving up on the true self.

 As I journey and take life day by day, it’s clear that being able to focus on living in the consciousness of life means taking personal inventory. It’s about being truly accountable and aware of my thoughts and actions, and eventually letting go of the diseased thoughts and behaviors that do not serve me well. Along with this comes the need to celebrate each small victory, to ask for help when I need it, and to put ME first.

I’m not suggesting that I’ve fully arrived at this place of better consciousness. There have certainly been moments where I feel I’m moving towards an appreciation for life and an ability to look at things more simply. I am relinquishing my diseased voice rather than hiding from it. By being more present in our own consciousness, we can move further away from fear and closer to  love and acceptance of our true self. Does that mean that the diseased self goes away? I do not have an answer for that. Perhaps it is always there, but for today anyhow… I will affirm:

 I am love, peace, & joy. This is how we were ALL created. Today is my consciousness and my choice. 

Our first blog entry comes from a woman who has been in treatment for several years and who has been in different treatment facilities and venues. It is about responsibility and accountability. It is refreshingly straight talk. What do you think?

Trigger-Happy

            There are several words and terms that seem to have acquired special meaning within the eating disorder community, some of which I believe have been have been psychologically helpful and some of which, well, not so much.  An example of a helpful phrase is the term “weight restoration,” which can be used in place of the phrase “weight gain” to describe the goal of eating disorder patients whose bodies have fallen below their natural set points during the course of their illness.  Some portion of eating disorder patients must gain weight in the course of their recoveries.  However, the phrase “weight gain” has come to be seen, culturally, as a bad thing that happens when a person mindlessly overeats or is very inactive.  (If you read in some tabloid that Oprah is gaining weight, you will probably feel inclined to pity her rather than celebrate her progress.)  “Weight gain” is associated in Western culture with laziness, ignorance of proper nutrition, pathology, or indifference.  The term “weight restoration,” on the other hand, implies something very different.  It implies that a person is making a deliberate effort to gain weight in order to “restore” his or her body to its natural form or, at least, to a certain standard of health.  The difference is practically nonexistent but psychologically important.  The term “weight restoration” is empowering, while the term “weight gain,” in our culture, implies loss of control, which is frightening to most people suffering from eating disorders.

            Now that I have given an example of a useful eating disorder-specific phrase, I am going to proceed to the “not-so-useful” phrase that is truly the subject of this article.  “Trigger” is a term that I have heard used ad nauseum in inpatient eating disorder units, support groups, group therapy, etc.  I have used it myself at many points in my early recovery and, therefore, know how attractive it can be to someone who wants to explain eating disorder symptoms without making reference to personal responsibility.  It is very tempting, for example, to say that a comment by a friend or a magazine cover about “scary skinny” celebrities or a talk show about dieting triggered me and thereby caused me to use a particular behavior.

            I want to look at the word “trigger.”  It is a word that traditionally refers to the device on a gun that, upon depression by the finger, causes the gun to fire.  Let’s imagine then that “firing a gun” refers to using a particular eating disorder behavior.  In this sense, every person with an eating disorder owns a loaded gun, because he or she has the capacity to use a behavior at any moment.  But what activates that gun is no different for an eating disorder patient than it is for a marksman: The finger that activates the gun belongs to the eating disorder sufferer and no one else.

            I will refer to a personal example here to explain my point.  I now have about three years of recovery under my belt, thanks largely to a residential treatment center that brought me to my senses after having been ill for about nine years.  If forced to grade my recovery at this point, I would give it about a B.  My weight is normal and I no longer do any type of purging; however, I still go through periods in which my depression significantly reduces my appetite and, in my weaker moments, this makes me feel as if I have a legitimate excuse to not eat.  I had one of these periods this summer and my boyfriend told me just last night that he had been concerned about me a few weeks ago because he felt that I was beginning to “push the envelope” of thinness and is relieved now that this is no longer the case.  I wish I had taken this is a compliment.  I wish I were a normal person who thought, “Wow…I guess I was starting to look a little weird a few weeks ago, and now I look beautiful again.  Hooray!”  But I am not that person.  My initial thought was, “Good Lord…have I really gained a ton of weight during the past few weeks?  How did this happen?  I must be fat now.”  I felt myself lapsing into a mindset in which I wondered if I should cut my intake in order to bring my alleged weight gain to a halt and perhaps even reverse it.

            And here is where I make my point.  If I were to begin using eating disorder behaviors at this point, could I fairly say that it was because “my boyfriend triggered me” to do so?  I would say “no,” and would very much hope that you would, too.  My boyfriend loves me.  He thinks that I’m beautiful and worries about me when my body becomes less beautiful than it normally is through weight loss or other behaviors.  To say that my boyfriend triggered me is to say that he fired my “eating disorder gun,” which is something that he neither would have wanted to do nor even has the capacity to do.  The gun is my gun and only I can fire it.  So, yes, his comment caused my slow-to-die eating disorder to awaken, very disoriented and cranky, from its slumber and say, “You’re fat, you’re fat, you’re fat.”  But, luckily, my eating disorder cannot fire my gun any more than my boyfriend can.  A marvelous aspect of having a brain with the capacity to make choices (and, assuming that you have undergone even a few months of eating disorder treatment, the knowledge to make the right choices) is that you can decide to remove the bullets from your gun, put it on the table, and, eventually, refuse to use it ever again.

            I want to make clear that my goal here is not to criticize those who use the word “trigger,” in particular because I belonged to this group at one time.  It is a word that seems to have gained popularity in the eating disorder community and that many have probably used without even considering its implications.  My goal here is to be empowering, not critical.  I think that the word “trigger” is dangerous because I have heard it used as an excuse more often than not.  For example, someone who says that she was “triggered” to lose ten pounds by a magazine article probably wanted to lose ten pounds (thanks to constant pummeling by her eating disorder) before the article was ever published and is subconsciously relieved that she can blame her behaviors on something external to herself.  Scapegoating is not unique to eating disorder sufferers; it has been found in every society in some form at every period of time.  But the fact that it is ubiquitous does not make it useful.

            Empowerment IS useful.  Knowing that, regardless of what someone says to you or what you read in a magazine or what you see on TV, you still have the capacity to control the course of your own recovery is useful.  And, so I encourage you to avoid terms like “trigger,” especially if you are using them to justify some behavior.  When something causes a mental hiccup in your recovery, consider what presuppositions in your own mind might have caused it and try to learn about yourself and your recovery by examining those presuppositions.  (To use my own example, a presupposition that I clearly have is that “All weight gain is bad/lazy/evil, even if it carries me from an unhealthy point to a healthy point.”  This is a dangerous and counterproductive perception, one that I clearly need to challenge.)  And, more importantly, think long and hard about your goals and values before you fire your gun.  If you are lucky, firing off a round will not result in a fatality, but it will always result in a mess.  The choice to avoid this is entirely yours.

Seeking Truth…A Blog That Might Feel Bad:

Real Insights Into Recovery

So much of what I hear and read about love songs to bodies and pandering platitudes about goddesses that I get really angry and frustrated with the direction of some of these self-help and treatment approaches.

Recovery from an Eating Disorder and Body Image Illness is tough work…maybe combat. It is about identifying stuff in your diseased self that you  wish someone could cut out. It is about pain and loss…not “light and self awareness.” It takes guts, honesty, spirit, sisters and brothers, and maybe a longing for a higher power.

So rather than a soft and feminine spirit awareness, this blog seeks to channel warrior hardness and warrior willingness. Yes, I am a male therapist. And what I seek to bring to my patients is a balance of hardness, understanding, compassion, and forgiveness that is found in the person who serves and who survives with companions in combat. The strife is not soft, the situation is not sweet, and the resolution is often far less forgiving than expected.

In the pages that follow, I will post honest, hard, real stories and ideas about recovery and treatment. I would like, with your help, to answer the hard and often unasked questions. It is my hope that the real warriors will have their stories told and remembered…rather than the sweet and seeming songs and poems of “pretty recovery.”

So send in your combat journals, send in your injuries, send in your wounded comrades, write in your observations of the situation. I will screen all against my beliefs of the above and the wellness of readers, and may edit (with your permission) your thoughts and post only with your permission.

Participate with strength and honor.

God bless and keep you all.

Dr. Erwin