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**trigger warning – food pictures and descriptions below**

One thing I’ve been trying to do this summer is get back to back to eating in a way that lines up more closely with my ethical system. Obviously, there is the veganism. But, there are other things too – like going to the farmer’s market, eating organic (or, as organic as I can afford), focusing on whole foods (by which I mean unprocessed foods, not the store), aaaaaannnnnd cooking!!! Cooking is still largely overwhelming to me. Something about combining ingredients and trying to count it all creates very high levels of anxiety, confusion, etc. Portioning is also difficult, so I eat more pre-portioned things than I would like, because of the trash associated with it. But, I figure, the first aim is that the food has to get into my body, and for now if that means I have some frozen Amy’s meals or some pre-portioned things, I’m going to let that be okay.

I am, however, making progress now that it’s summer. I have more time to plan food, deal with the anxiety, go to farmer’s markets, etc. One thing I’ve learned is that when I reincoporate something back into my diet – tempeh, most recently – I need to eat it a few days in a row if it’s going to “stick.” Also, as an incentive to cook, I bought myself a new cast-iron skillet. For a while, I wouldn’t let myself cook in cast-iron because it’s the “best/healthiest” way to cook because supposedly you actually get more iron in your diet that way.

With cooking, if I stick to whole, vegan ingredients (and not too many ingredients or it gets overwhelming), I’m actually starting to get some enjoyment out of it again. And I’m actually starting to feel good about what I’m putting in my body. I had forgotten what this felt like.

So, for example, one of my new favs to cook is a vegan tofu scramble:

It includes: lite firm tofu, tomatoes, cilantro, onions, mushrooms, red and yellow peppers, Spike seasoning, Bragg’s essential aminos, garlic, dried basil, Daiya vegan “cheese” sprinkled on top (gotta get that endurance fuel!*)

This is a meal that I have come to feel good about. At some point I need to be able to use regular (not lite) tofu, and oil (not just pan spray), but this is a big step. I hadn’t let myself eat this (too nourishing) in probably a year or so. Maybe a bit more. Now it’s pretty thoroughly reincorporated.

And then there’s traveling when vegan and in recovery. I’m going to D.C. for a few days and I have absolutely no idea what the food situation will be, the availability of vegan food, etc. So, my RD and I did some planning. My packing chaos looks like this:

Let’s just say: 8 soymilks to stand-in for supplements, some granola (new food!), vegan Luna bars, vegan Clif bar & Clif zbars, fruit leather, Annie’s vegan gummy bunnies (new food!), chocolate covered soy nuts (new food! And yes, I’m super annoyed they’re south beach as well), vegan nu go bars (my fav protein bar), vegan wheat crackers, primal strips (vegan jerky), electrolyte water (no dehydration for me!). This is more than I would normally take for four days, but since the availability of vegan food is questionable at best, I am prepared for a worst-case scenario in which I have significant trouble meeting my nutritional needs at meals. Some of these foods are highly processed (the bars, ahem), but overall, they’re foods that I feel good about putting in my body and I feel secure knowing that I have the means to stick to vegan foods so that I don’t have to deal with the anxiety/frustration/disappointment in straying from that.

So, I’ve been thinking about veganism and the role that it plays in my recovery – specifically in regard to choice. First and foremost, let me reiterate: I am an ethical vegan. My veganism extends beyond my food choices – I don’t wear animal products (leather, wool, silk), and all of my personal care products (shampoo, soap, shaving cream, make-up, etc.) are vegan. But, in the eating disorder world, veganism is often equated with restricting (Aimee Liu makes this mistake in Gaining, a book which I otherwise thoroughly LOVE). Yes, being vegan limits your choices. If you’re not vegan, think about your favorite restaurant. Think about what options on the menu would and would not be viable if you’re vegan.

This is what gets a lot of people up in arms. The response often is, “You just want to be vegan so you can restrict!” Of course there are some people who are ill who use veganism/vegetarianism in that way. But, the restriction is not about the vegetarianism. It’s about the eating disorder. And if one is going to actively engage in the eating disorder, one is going to actively engage. Claiming veganism might make it a bit harder to spot to other people, but the restriction is about the eating disorder, not the veganism, and if one is determined, it will happen, vegan or not.

So, let’s think about dopamine now. One of the posts that I linked in my last post – Structured on the ED Bites blog by Carrie Arnold – discusses the fact that people recovering from Anorexia Nervosa often need a meal plan because our brains process dopamine differently, and therefore we have very little gauge of whether we are making “the right” decision. So, without that internal gauge of “Yes, this is good” or “No, this is harmful,” decision making can quickly become overwhelming. So, that’s why many patients may find it helpful to have a meal plan to help them structure and guide the the decision making process. Carrie Arnold also talks about how choices often need to be limited – the example that she uses is that instead of saying “What kind of grain would you like with dinner?,” it might be more helpful for someone recovering from anorexia to be asked “Would you like rice or pasta?” (I think that this must be partially why grocery stores are so daunting for so many of us. SUCH an overabundance of options.  – What do I choose? Am I making the right choice? How do I know? Should I get this or this . . . or this . . . or that?!) I’ve seen my RD use this tactic with people when they’re struggling with meeting their meal plan in nutrition group – if they need more, she just comes over to them with a couple of options and says “Choose one” or “Choose two.” Or, she might say, “Would you like nuts or a supplement?” But it’s never, “How do you want to make up for that?” because . . . so many options! How would one know what decision to make?

So, what if the structure of veganism isn’t bad? For me, the fact that being vegan often pares down an overwhelming abundance of choice is really, really helpful. Sometimes when I go to strictly vegan restaurants, I get someone paralyzed by the multitude of choices (What do I get? What if I don’t choose the right thing? What if I think I know what I want, but I don’t? What if I want something else after I’ve already ordered? What if I want two things? How do I pick? Etc., etc.) It’s too much; I can’t gauge if I’m making the right choice. I think that further into recovery, this will improve as I keep having healthy choices externally reinforced by my treatment team. And it’s better than it used to be. But, what if one of the fringe benefits of ethical veganism is helping reduce the anxiety of overwhelming choice? What if veganism *in recovery* actually makes eating more manageable, not more restrictive? What if people with eating disorders are actually capable of having ethical/spiritual/moral beliefs that affect what they good about putting in their bodies, as I’ve mentioned in a previous blog post?

What if the fact that so many people go through at least a “phase” of vegetarianism in recovery is about making overwhelming choices more manageable? What if those of us in recovery need ongoing methods to help structure our decision-making? Is that really so bad?

I was catching up on my google reader (I’m WAY behind, clearly) and saw that the executive director of my treatment center got coverage on the ED Bites blog, by the wonderful Carrie Arnold. (I’m sure some of you follow this blog; it’s a well-known one!) In fact, she liked her presentation at the 2010 Salzburg International Conference on Eating Disorders so much that she dedicated two posts to it. Yay!

Post #1 is on “The Noisy Brain,” eating disorders, and eating disorder recovery. Found here:

Post #2 is on the need for structure and meal plans in anorexia recovery specifically, and it talks about how neurochemistry impacts decision-making, etc. Found here:

I commented on the entries, under this blogger name – Sayhealth. I’d love to hear your thoughts!

I feel so absent! I have so much that I want to write about, but alas, midterms hit last week. For me, that meant my own midterms as well as grading student papers! It’s been a bit daunting. But, I think I’m in the clear – at least for another week or so.

I’m off to a conference later today – The National Women’s Studies Association – in Atlanta. wOOt! Come on, weather in the 70s! 🙂 Hopefully it also means I’ll have some downtime to blog. Some things I’m thinking about – ideas sparked from other blogs (Surfacing after Silence and When Ed Moved In) as well as some things that have come up in support group, with friends, etc – are:

– The role of humor in e.d. treatment and recovery.

– Eating disorders as a “choice”

– Eating disorders, eating disorder recovery, and identity.

– Importance of liking, and feeling liked by, treatment providers.

I’m also WAAAAY behind on reading blogs, so I suspect I’ll be thinking about more as I catch up. And I still need to reply to a couple of comments on my last post! If any of these topics pique your interest, or if you have any thoughts about them, please let me know!

Well, actually I’m not. I’d like to, but I don’t have a horse. Also, I don’t really know how to ride. I’ve only done it a handful of times, and I’m *still* amazed that I didn’t bounce right out of the seat when I hit a canter.

I want to address this article about eating disorders and equine assisted psychotherapy (EAP) that is circulating the internet at an impressively fast rate!

First, let me locate myself so that you know where I’m coming from. I have not participated in EAP. Do I think it would be beneficial for me? Absolutely. Do I think I can recover without it? Of course. Though EAP might be helpful for me personally, I know I can recover without it because I recognize that EAP is one tool among many for treating people with eating disorders, and not a primary treatment. Though I’ve never worked with animals as a client, I am very interested in the use of therapy animals to promote healing. There’s a very good chance that I will incorporate animals into my own clinical practice someday.

What shocks me about this article is not it’s skepticism – many people are skeptical of EAP, and I think that’s largely because it’s true that not a whole lot of research has been done on it. However, not a whole lot of research has been done on the use of DBT with people with eating disorders,* and yet the author of the article is willing to jump on board with that (he even considers it an empirically-supported treatment, even as he recognizes that the empirical evidence has serious holes). No, what shocks me is that people are backing this article even though the author has a very clear, very strong bias. I know that science isn’t bias-free. I absolutely think our cultural and individual values will influence what we find and what we look for.

But, really, in this article, in the *third* sentence, he describes the reaction of him and his wife as “appalled.” Okay, he’s not a fan. I get it. But, seriously, if this article were on DBT and the author made such a strong, negative pre-judgement about the use of that therapy, I’d hope that people would be as skeptical of the author’s biased viewpoint as they are of the therapy. Or at least, I hope they’d take it with a salt lick.

He makes the point that EAP is said to be helpful for a wide-range of mental illnesses. Perhaps this is presumptuous. Perhaps it is not. It’s hard to say without the research. But, CBT has been shown to be effective for a whole host of mental illnesses, and yet that’s not questioned in the same way. And yes, we have research to support CBT. But CBT did not magically become effective when the research said it was. It was ALREADY effective, just like EAP might be. Maybe EAP is effective for some disorders, maybe not for others. Maybe it’s effective for some clients, but not for others. But what is the harm in having more therapeutic tools and experiences at our disposal? And have we considered that perhaps there’s not a whole lot of research on EAP because it’s so often stigmatized, or delegitimized before its researched? (This is not the first article I’ve seen like this recently.)

The thing is, EAP, like DBT actually, is not meant to be a “first-line” therapy in the treatment of eating disorders. It is meant to supplement other modes of treatment. And yes, there is not a lot of evidence for that. And, at the same time, it doesn’t take a whole lot of expertise to look around and see that for some, working with or being in the presence of animals helps them to open up in ways that they might generally feel unsafe doing. Obviously this is not true of everyone, and just like every treatment method used for eating disorders, EAP should not be used for everyone. It’s not a panacea. Nor is DBT. Nor is CBT. Nor is re-feeding. Nor is FBT. Nor is psychotherapy. Nor is nutritional counseling. If there is one thing we know about eating disorder treatment, it is that, more often than not, treatment requires multiple kinds of care and multiple therapeutic modalities to be effective.

So is the jury still out on EAP? Sure. Is it still out on DBT? Yes. Is the neuroscience that many of us are rallying behind still quite new? Yes. But one of these things is not like the other. Why the premature writing off of EAP? Sure, there needs to be more research done. Absolutely. But what if we left the possibility open of having another way to heal people, rather than having such a strong (and premature) bias against it? Frankly, the fact that the research is yet to be done also means that we haven’t proven that it doesn’t work. It could be incredibly effective for treating eating disorders, and we wouldn’t know that yet either.

Every treatment had a time when it lacked evidence. Every one. That’s the nature of research. So, personally, I’m going to support the use of EAP for clients who feel it would be helpful. If you ask me, the more treatment methods there are, the better equipped we’ll be to meet the individual needs of clients who are fighting this devastating illness!

* I have nothing against the use of DBT in e.d. treatment. I’m actually a proponent of it, and I personally have benefited immensely from having DBT be part of my current treatment. That said, there really is very little evidence to prove it’s efficacy for e.d. treatment yet. The small amount of literature that is there is focused mostly on bulimia nervosa and binge eating disorder. But someone has to be the pioneer if a treatment will ever gain empirical support!

First of all, thank you all for your comments on the last post! I decided not to respond on that post because it was really about hearing others’ opinions, and I did not want to impose my own.

I will, however, proceed to do that now. 😉 Thank you for humoring me!

Like a few of you said, I absolutely agree that patients/clients should have input as far as whether or not they know their weight. And, I acknowledge that this can be a challenge, especially with patients who are having trouble separating what is best for them and what is best for the eating disorder. When I had my intake with my current nutritionist, we went to the scale, and she just said something like, “We do blind weight here.” It wasn’t presented as a choice, though obviously if I had protested, we could have discussed it (I know that she lets others see their weight because not knowing triggers them). But, I didn’t protest because I was RELIEVED. I know that she if she had presented seeing my weight as a choice, I would have chosen to see it. My motives in seeing would have been driven by the e.d., as I know that I do better with blind weights. But, at that time, I didn’t have control over the e.d.; I would have looked because that’s what Ed wanted. I needed her to take control over Ed by making the decision to do blind weight, because I was not capable of doing so at the time.

I think that, for patients in the later stages of recovery, the decision about whether or not they see their weight should be made in collaboration with their treatment team. I fail to see how wrestling control and agency away from a patient in this area would be helpful to recovery. So, if a patient wants to know her/his weight, and if the treatment team agrees that it is for recovery-positive reasons, I absolutely think that the patient’s weight should not be kept from her/him.

That said, I also think that a patient should not be forced to see her/his weight. This recently happened to a friend of mine, which is what inspired this post, and it was incredibly detrimental to her, and bolstered her e.d. And I actually think that it’s quite possible to go for a very long period of time without knowing one’s weight. I went for a period of years without knowing, and now, unless I let myself look at a GP appointment, I don’t know what it is. If a patient chooses to continue with blind weights, yes, it will take a bit of a commitment to maintain that outside of the treatment center – they will have to ask to skip being weighed or be weighed backwards at Dr. appointments, they will have to commit to not buying a scale, etc. – but it really is very do-able. And there are other ways to gauge one’s weight that allow a bit more for natural fluctuations in weight – how one’s clothing fits, for example. I think we confront the reality of our weight and/or changing weight everyday, whether or not we label it with a number. And I think that, for someone who continues to choose blind weight, if she/he does encounter a number unexpectedly (on a doctor’s chart, for example), if treatment has been truly effective, she/he will be able to cope productively.

Personally, I’m glad that my team enforced blind weight when i needed them to, and I am glad I’m able to choose to continue with it. AND, I’m glad that for other people, they us different methods – one’s that are more effective. I guess this goes back to my firm belief that, generally speaking, e.d. treatment – including whether or not patients know their weight – needs to be about the individual, rather than about blanket policies.


*disclaimer* This might be “ranty.”

I’m a vegan. I’m a vegan with an eating disorder. There! I said it.

Well, okay. I’m 100% vegetarian, and a “relaxed” vegan. I eat vegan the vast majority of the time, but I will make occasional exceptions (like, for example, the fun size reese’s pieces that I’m having right now).

I went vegetarian at 16, when my eating disorder was active. I will be honest and say, yes, of course my e.d. influenced that decision. My e.d. influences many, many decisions. It influences, for example, what I put on in the morning. Does that mean I shouldn’t wear pants? Of course not! B/c even though my e.d. might influence what pants I put on, I also recognize the fact that there are many more important, practical, clear, logical reasons to cover up my bottom half today – the weather, public indecency laws, comfort, boundaries, etc. Plus, I just want to wear pants. Probably my cords. Ed might try to influence the decision, but ultimately I am going to wear my cords (whether Ed likes it or not) for reasons far beyond my e.d.

As probably many eating disordered people can tell you, when you have an eating disorder, it influences a HUGE number of decisions – big and small – that you make throughout the day. It’s the all-encompassing nature of the disease. Does that mean my decision to wear my cords today is ALL ABOUT, or even primarily about, my eating disorder? Of course not. That would just be silly!

And I know that food choices are different than pants choices. Food seems more central to an e.d. because that is the symptamotology. Though, I would argue that clothing/size/body image is also very much impacted by an e.d. But, yes, I understand that they are not the same.

What is the same is the fact that, though my choice to go vegetarian may have been influenced by my eating disorder – as so many decisions are – it was not the primary reason I went vegetarian, nor is it now. I went vegetarian initially because I love animals. I love them. I knew that I personally would never be able to slaughter an animal, to take its life, to eat it. When I really thought about this, it seemed unethical to me for me to allow someone else to do that in my name. As I learned more about the meat industry in the US, my ethical decision to be vegetarian was reinforced. Then, as I became Quaker and pledged to live in accordance to non-violence, I saw vegetarianism as in line with that too. So, the reasons are actually logical, rational, and very clearly line up with what I believe. It seems that I have an eating disorder AND *gasp* reasonable, clear, healthy, competent reasons for being a vegetarian.

And, yet, over time, I had it drilled into my head (by books, by doctors, by family members, by some e.d. professionals and activists) that an eating disordered person who is vegetarian *must* be using it to restrict. So, during one of my early periods of recovery, I gave it up. I stopped being vegetarian. I thought I needed to give it up in order to recover. Though I recognize that this may be the case for some people, personally, I regret this choice. My weight skyrocketed above my set point. I felt sluggish. I wasn’t digesting well. And, mostly, I felt like I was living a lifestyle that went against many of my core values. After about eight months, I switched back to being vegetarian. I missed it too much. I missed the lifestyle. And after switching back, I felt so much better emotionally, mentally, and physically. AND I had the medical tests to support it – my weight gradually went back to my set point, my iron levels actually went UP, my vitamin &  minerals were coming from my plant-based diet rather than a tablet, my protein was in a realistic range that my body could use, rather than sky-high like many people’s. My energy came back. I slept better. For my personal body, it seems, vegetarianism is the way to go.

And yet, I still get flack for it a lot of the time. I get things like, “You lost weight because you’re vegan.” No. Dead wrong. I lost weight because *I have an eating disorder.* Let’s not confuse the two. They’re not necessarily synonyms. I also read things with alarming frequency that are skeptical at best and downright disapproving at worst in their assessments of vegetarianism in people with eating disorders. I keep thinking that people will realize that assuming vegetarianism is about restricting is unfair. And yet, it keeps coming up time and time again.

The book “Gaining” is the most recent thing that I read, which is what inspired this post. I had heard so many good things about “Gaining” – that it is progressive, that it is insightful – and, in many ways, it is. Until the lauded example of the e.d. dietitian who, when confronted w/ a vegetarian client, would “test” them by asking what animal rights organizations they were part of.

REALLY?!!!! This is where I almost hurled (involuntarily) all over the book  in Border’s. First of all, people choose vegetarianism for all sorts of non-eating disordered reasons that may or may not have to do with animal rights. Second, REALLY?!! Are we going to tell a a client that she’s not Christian if she’s not actively going to church?? Are we going to tell a client that he’s not against racism if he’s not a member of the ACLU?? Are we going to tell a client we don’t believe she’s a feminist if she’s not a member of NOW?? Are we going to tell a homosexual client he doesn’t support gay rights if he’s not a member of the HRC?? We don’t all join groups to support our core beliefs. And yet, vegetarians somehow have to “prove” their vegetarianism is for the “right” reasons with this litmus test.

I’d like to suggest another approach. What if, instead of immediately creating an environment of skepticism and mistrust by interrogating a client’s vegetarianism, e.d. treatment providers create a space of non-judgmental curiosity and trust that would encourage a client to open up about their reasons for vegetarianism? That way, a client who had chosen vegetarianism as a way to restrict (and, yes, of course I acknowledge that this happens) could ask for help from their RD and treatment team without fear of being told “I told you so” or being judged. Also, that way a client who was an ethical vegetarian could actually have support in having BOTH their ethics AND their recovery.

You know what the skepticism about vegetarianism in the e.d. community does accomplish? It’s incredibly effective at keeping a lot of us out of treatment. I know a number of eating disordered vegetarians who won’t see e.d. dietitians because they fear they will be questioned at best and condemned at worst. Last I checked, there were no IP programs that would support veganism. Some will support vegetarianism, though many won’t. Most residential programs will not support veganism, and often those few that do merely “tolerate” it – be prepared to eat A LOT of peanut butter & jelly (not sure how this helps break repetitive eating). I know a number of people who have gone to residential programs (that shall remain nameless) and were told before admission that they could remain vegetarian, but upon arrival the rules changed (NOT helpful in any psychiatric treatment) and they were told that their vegetarianism was a means of supporting their eating disorder, and the RDs wouldn’t work with them as vegetarians. I have seen them after discharge at my treatment center, wanting to switch back to being vegetarian, but they have had their own sense of self-trust undermined. Those who do switch back for healthy reasons, then have to restructure what they eat yet again under the guidance of the RD at my treatment center. Big dietary changes like this can be difficult for anyone, but especially for people in recovery, vegetarianism or not.

Personally speaking, I put off seeing an RD for quite some time last year because I did not want to have to battle over my ethics. Then, I found my current RD’s description on my treatment center’s website, and her bio said very clearly that she specialized in eating disorders AND was interested in vegetarian diets. I immediately made the phone call. If she hadn’t had that statement on the website, I may never have found my way to my incredible treatment center. I have switched to being vegan while working with her, and it has actually been incredibly beneficial to my recovery. When I decided to switch to being vegan, my RD did ask me about it. Like I said, I do realize that there are people who use vegetarianism/veganism as a way to restrict. So, yes, I think it’s very important for treatment providers to have open and honest discussions with clients about their food choices, perhaps even at multiple points in treatment. And that’s what my RD  (who’s not a vegetarian, for the record) did with me. When I told her I was thinking of switching to veganism, she asked me, with curiosity and compassion rather than judgement, about my reasoning. She asked me if and how I thought it would impact my recovery. I told her my reasons, explained my ethical views, my understanding of veganism and my recovery, etc. And she trusted that I was making reasonable, healthy, competent decisions based on my food politics and ethics. Because of that trust, I have had the benefit of an RD’s guidance as I transitioned to veganism. And it has been so beneficial to my recovery. Often in the support group that I attend at my center, there are other vegetarians and vegans who inevitably at some point mention that they are so grateful to have found a treatment center and an e.d. dietitian who will support vegetarianism/veganism. It has made treatment possible for many of use who had been met with with (and still often are met with) skepticism and mistrust when we have simply been trying to live a life in accordance with our reasonable, rational, mature, competent ethics and beliefs.

Do any of you have experiences with this? What are your thoughts on the matter? How do we balance food politics and eating disorder recovery?

This is something that I’ve been wondering about for a while, and something that has come up in conversation with a few friends in recovery lately. I get the feeling that this is something that people are perhaps hesitant to talk about because we don’t want to be seen as judging others based on body size, etc. I know that’s the case for me anyway.

But, if I’m being totally honest, the body types of my treatment providers DO matter. Obviously they are not the be-all and end-all determinant of whether or not I’ll work with someone. Much more important to me is the level of mutual respect I feel w/ my team members, how easily I am able to trust them, whether or not I connect with them, their views about e.d.’s and treatment, etc. But, at first, their body type IS quite important to me. In therapists, I want someone who is “average,” or even perhaps a little bit above “average.” B/c my set point is a bit on the higher side of normal, I prefer to have a therapist who has experienced what it’s like to move through a thin-obsessed society with a body that is, well, not thin. If I have to go through a weight gain process, I also tend to be less self-conscious doing that with a therapist who is not particularly thin.

Dietitians, however, are another matter. I hate to say it, but, at least when my e.d. is active, it would be a struggle for me to work with a dietitian who was not slender. My first RD was very small (she was clearly just built that way), and that was a bit hard for me because I felt so big in comparison. My current RD is thin, not skinny; she looks like she is a very healthy weight for her frame. Slender, but clearly not disordered. This appeases my e.d. a bit, and it encourages me that one can nourish oneself and not be overweight (something that I absolutely believe in regard to other people, but I have trouble applying to myself). And frustratingly, these kinds of standards, expectations, etc. based on size are in direct opposition to what I believe in my daily life about size, etc. I’m actually a firm believer in HAES (health at every size) and a proponent of body diversity. Yet, when it comes to my treatment team, I have preferences.

What about you? Does the weight/size/body type of your treatment providers matter? If you’re a treatment provider, is this something you’ve considered? Is it something you’ve talked about with clients?

I know this can be a sensitive subject, but in my conversations with others, it seems like it’s something that can be important to people and should be open for discussion. And I’d like to think this blog can be a forum where we can all discuss these matters honestly and without judgment. 🙂

There’s a Lutheran Church that I often drive by on my way to Trader Joe’s. Out front, they have a number of banners. The one that caught my eye was a banner that reads, “Relentless Compassion.”* Maybe it’s because I’m often on my way to Trader Joe’s after an appointment at my treatment center, but when I first saw that phrase – relentless compassion – I instantly associated it with my team.

And let me tell you, they are relentless. My RD has actually said to me, “I know that it’s hard for you to hear good things about yourself right now. AND, I think it’s important to really acknowledge and highlight the amazing work that you’re doing and the progress that you’re making.” My team *always* meets me with compassion and kindness, even when Ed has caused me to lash out at them, even when I’ve had major slips or setbacks, even when I’ve tried my best to convince them they *shouldn’t* be kind to me because I haven’t “earned it;” I’m not the good person that they think I am. Try as I (or Ed) might to convince them that I didn’t deserve that kind of care, they were relentless. I was forced to resign myself to it. I realized that these people were going to be nice to me, and there was nothing I – or, more accurately, Ed – could do about it!

Now don’t get me wrong, I have had numerous other treatment providers who’ve been wonderful, and kind, and consistently supportive. But, I have never experienced it like this. In the past, even the kindest of treatment providers (with a couple of exceptions), have become overwhelmed by my symptoms at times. My old RD, for example, was one of the kindest, most compassionate people that I’ve ever met. Yet, there were days when I left her office feeling overwhelmed or like I had let her down because we spent the entire appointment focusing on what I still needed to work on, or what had gone awry since the last time I saw her. Obviously the goal was not to make me feel overwhelmed. I doubt that she was actually disappointed. And, I understand that eating disorders are dangerous, so in the name of my health, she wanted to focus on progress, on what I still needed to do. And though this came from a very obvious place of care and support, Ed could still wrestle it from me and turn it into, “Look how you’ve screwed up. Again. You still have so far to go.”

With my current team, dare I say something like, “I’m sorry I fucked up again,” or, “I should be recovering faster; I still have so far to go,” it is always met with, “And what progress have you made this week?”, or “What’s one thing you have done to care for yourself this week?” or “And how does now compare to when you first started coming here?” A big part of this is the practice of dialectical thinking. My treatment center uses a lot of DBT. So, when I go all black-and-white in my thinking – when I start belittling myself for not doing well, for not being perfect in recovery – I am encouraged to think of the ways that I am progressing. That way, we can acknowledge and legitimate everything. I can be struggling, AND I can still be working toward recovery. I can want recovery AND I can be scared of it. I can slip AND I can get back on track.

But, the relentless compassion and kindness extends beyond the use of dialectics.. I learned early on that there was nothing I could do that would make these people give up on me. There was nothing I could do that would cause them to write me off as “chronic,” as others have occasionally done. And, though Ed made me try many, many times, there was nothing I could do to convince them that I don’t deserve treatment, that I’m hopeless, that I’m wasting their time, that I’m not the good person that they think I am, that I don’t deserve the credit they give me.

This is a big shift for me. Having lived with my e.d. for so long, the messages that I get from Ed now extend FAR beyond food. In fact, Ed’s favorite tactic is telling me that I don’t deserve, well, anything. Ed tells me that thinking that I deserve something is equivalent to taking things for granted, and I have no right to deserve things or take things for granted when others in the world are denied or do not have access. Obviously Ed tells me this applies to food. But, it also applies to compassion, care, and, yes, treatment. The message goes something like this, “You don’t deserve (insert food here). Other people in the world don’t get it, what makes you think you have a right?” Or, “You don’t deserve this level of care. You don’t deserve this level of kindness. You’ve done nothing to earn it.” From my conversations with other eating disordered people, I know that many of the same people are getting the same messages (lies) from Ed.

My team seems to understand this. So now, I am met with constant (relentless) reassurances that not only do I deserve to take in the nourishment that my body needs, but I am also deserving of treatment, I am deserving of self-care, I deserve to do things because I *want* to, I am deserving of a team that “isn’t going anywhere,” I am deserving of health, I am deserving of treatment even in the face of insurance denial, and I deserve to hear positive things about myself and my recovery, even if it makes me uncomfortable, even if Ed makes me try to convince them I’m wrong.

Like I said, it only took a couple of appointments before I realized that these people were NOT going to stop. They were going to be kind to me whether I liked it or not. They were going to point out positive things about me. They were going to remain absolutely convinced that I deserve treatment. It was out of my hands. This was one area where I had no control. And the kindness was going to start from the very moment I checked in with the receptionist at the front desk, through my appointment, and until the moment I left.

I was skeptical at first. I thought that it was cute, what they were doing. It was a sweet tactic, but it would never take hold. At the very least, I was determined to remain convinced that I am undeserving – a safeguard against taking things for granted. I thought it was nice that they wanted to show me kindness, but it was naive. It would never take hold. At first, when they complimented me, or told me I was deserving, or rerouted negative thoughts to positive thoughts, I (Ed) would try my hardest to combat them, to convince them they were wrong. When that tactic failed, I decided they could say all of the nice things they wanted, but I wouldn’t listen and I would just remain silent and internally combat them.

Then, something happened. I was in my RD’s office one day and she was once again relentlessly referencing my progress and – I smiled. I couldn’t help myself! I knew she saw it, and I tried to repress it, but then she said something else about my progress, and I did it again! And then, later that week, I did it in my therapy appointment! I was actually having moments where it felt good, where it made me happy to hear someone being kind and compassionate rather than placing blame or focusing on the negative, or even just focusing solely on the work to be done.

The next step was that I found myself using their kindness to combat Ed. This is still often a tactic of mine. Ed will be giving me a negative message and I’ll think, “But my team has been so nice to me, and so committed, and I’m not going to listen to you because I don’t want to wast their time.” Or I’ll think, “But, my team says I DO deserve to eat protein and feel well, and they’ve been right about everything else, so . . .”

And, suddenly, this kindness is getting out of control! There are moments now where I – *gasp* – actually think that maybe I deserve to have people treat me this way. There are moments where I will give myself permission to not engage in a behavior because I deserve better. I want to feel better. I deserve to be kind to myself. These moments are still fleeting, and sometimes far between, but they are there. And they are increasing. Ed and the kindness that I’ve received from my team can’t coexist. And my team is proving to be just as relentless as Ed (well, actually, more relentless, it seems), and gradually, the kindness and compassion seem to be pushing Ed out. They’re literally killing Ed through kindness. And I seem to be jumping on the bandwagon, intentionally or not! Kindness is catching, it seems.

And don’t get me wrong, though this relentless compassion and kindness has been incredibly healing for me, I remain committed to my stance that successful treatment must employ multiple tactics. This kindness and compassion works, I think, because it is paired with *very* clear boundaries, skill development, therapy and trauma work, nutrition, etc. For example, regardless of how nice she might be, my RD will not compromise on my weight or my meal plan. My therapist may show me relentless compassion when I’ve been upset about exercise restrictions, but she will not change them. I’ve actually come to see this as a function of care. They care enough about me to *not* compromise in these ways; it is a way of keeping me safe. It is a way of being kind. It is “tough love,” as they’ve stated.

The kindness and compassion that my team shows me has truly fostered an environment of honesty. I know that I can be honest about my struggles, I can be honest about behaviors, and I will never be made to feel guilty or “bad.” The struggles will be honored and worked with, safeguards and boundaries will be put into place, AND my team will be kind and compassionate and positive through the ups and the downs.

There’s nothing I can do about. They’re relentless. And it seems to be rubbing off.

What are your thoughts about this (yes – YOU!)? Is a viable treatment option? Is it “too nice?” Have any of you had similar treatment experiences? Have they been helpful? Unhelpful!

* This phrase is actually borrowed from a UCC church called The Cathedral of Hope. “The Mission of the Cathedral of Hope is to reclaim Christianity as a faith of extravagant grace, radical inclusion and relentless compassion.” This is exciting for me because, though I am personally a Quaker, my father is a UCC Pastor. Yay!

Well. I finally got the time to read this great NY Times Article, Understanding the Anxious Mind. It’s long, but totally worth a read – thanks to edbites and Laura Collins for bringing this article to my attention!

What I really appreciate about this article is the way that it complicates both the biological model and the behavioral/environmental model of anxiety and brings them into dialogue with each other. It’s a desperately needed approach! The article demonstrates that biology/temperament may very well predispose a person to anxiety, but this biology is not destiny and these things are also difficult to quantify in a lab setting that is “artificial.” That’s a *very* rough and reductive summary of the nine page article, so I’d suggest you read it! 🙂

Anyway, some lingering questions that I have:

– The article clearly shows that while we may be able to see clearly neurological, structural, and tempermental paredispositions in people with anxiety, it also shows that many learn to manage this anxiety. For many, though anxiety might be present, it does not negatively impact their daily lives as they mature. So, one may have the biological predisposition, but she/he may not outwardly display anxiety, and she/he may not even necessarily feel heightened anxiety. I wonder, does this work the other way around? Can someone *without* the biological and tempermental predictors for anxiety learn anxiety – from their environment, caretakers, mentors, experiences, etc.? Can anxiety develop via experience/environment, without the biological predisposition?

– What are the implications for this as far as child psychology, parenting, family, etc.? The article shows that the jury is still out in regard to what are the most effective ways to nurture a child with anxiety so that the anxiety becomes manageable (I was a bit miffed at how quickly they feel into the individualist mindset with this). But, I assume that more theories and studies about this will follow. So, if a child shows these predisposition to anxiety, do parents have a responsibility to “deal” with it? Do doctors? Psychologists? How do we stress the important role of parents/caretakers/families in helping anxious children, without playing the blame game? (i.e. “Your child has specific needs that can be best met in this way.” v. “You didn’t raise your child ‘correctly’ so now she/he is an anxious adult!”) Obviously, though, a lot more work needs to be done on the behavioral/environmental side of this before they can draw any conclusions about what is helpful/necessary.

– How does this research impact eating disorders specifically? Research as shown that – at the very least in anorexia nervosa, which tends to be the most researched e.d. (though it’s the least prevalent statistically) – there are certain biological/genetic markers that may predispose someone to develop AN. So, my first question works for e.d.’s as well. Not *everyone* who holds these genetic/biological markers develops full-blown AN. So, there must be other factors involved. If someone can have biological markers, but not develop the full-blown disorder, can this too work the other way around?  Can someone develop the disorder without the biological predispositions? How? Why?

– How does an e.d. exacerbate anxiety? It is clear that when an e.d. is active, many other psychological implications follow – depression and anxiety, for example. This happens for a number of reasons having do to w/ (mal)nutrition & the effects on the brain, added stress in social situations, an increasingly rigid need for routine and order, etc., etc. How do clinicians and treatment providers acknowledge the anxiety and depression without falling into the trap of assuming it underlies the e.d.? For example, for some patients, the e.d. may be a way to cope with anxiety and depression that are already (and perhaps biologically) present, yet for others, the anxiety and depression are a symptom of the e.d. (and perhaps they do not have the biology for it). I have seen, more than once, people medically treated for anxiety and/or depression because it is assumed to be a chemical imbalance, yet in the long run, the medication has proven unnecessary b/c the anxiety and/or depression was a symptom of the e.d. and “cleared up” as the e.d. was treated. Yet, for others, an inherent biological predisposition to anxiety and/or depression may mean that medication is the most effective treatment. How can treatment providers best navigate this delicate balance?

– Are there temperamental signifiers that we should be looking at for people with eating disorders? Certainly many “personality traits” have been outlined for people w/ anorexia  and a bit for people with other e.d.’s (though, again, I wish there were more research for the other eating disorders!). For example, we often hear of people with AN as being ambitious/driven, type A, perfectionist, obsessive, etc., etc. Using myself as an example, I have always been on the “stoic” side of normal. Even as a baby, according to my parents, I was not as expressive as some (I did not laugh or cry as easily as many babies). I remember very clearly that as a young child (we’re talking preschool age) I expected myself to individually manage my emotions and keep them internal, so as to avoid burdening or worrying people. I was often asked if I was “sad” as a child, but I wasn’t sad. I was just stoic! I have no doubt that this internalizing of emotions and perhaps this inherent “stoic” temperament was influential in my development of an e.d. If we do find temperamental markers for the array of eating disorders, again, what implicaitons does this have for parents, caretakers, (mental) health care workers, etc.? If we find temperamental markers, can potential e.d. behaviors be rerouted before they start? Can a certain kind of environment based on tempermanet cut e.d.’s off at the pass, so to speak?

– The article stated that anxious people with high intelligence tended to be better at managing their anxiety. If there’s one thing we often hear about eating disordered people, it is that we are “highly intelligent.” I can’t even count the number of times I’ve heard something to the effect of, “But you’re so smart! How could you do this?!” Given that many people with eating disorders ARE highly intelligent AND highly anxious, what is the disconnect here? Why are these two characteristics so disproportionatly and concurrently present in people with eating disorders when intelligence seems to beneficially mediate anxiety in the more general population?

As always, the more “empirical” research there is, the more questions I have! And wow. This was much longer than I anticipated!

My name is Sarah. I am a graduate student, Quaker, animal lover, hippie, quasi-cyclist, feminist, partner to a wonderful man, (mostly) vegan. I’m also an e.d. survivor. My eating disorder started at age nine, with compulsive overeating. My family often used food or comfort, so I learned that food was a way to numb and “deal with” difficult or unpleasant emotions. My eating disorder switched to anorexia at age 15. Since that time, I have been bouncing back and forth between anorexia, bulimia, ed-nos, and recovery.

I’m now 26 and back in outpatient treatment. I relapsed last year (when I relapse, I tend to go all out. My relapses don’t typically last for days or weeks, but rather, months or years), and got back into treatment at the encouragement of a friend. My various rounds of treatment have always been on an outpatient basis, sometimes with specialists, sometimes not; sometimes with a whole treatment team, sometimes not. As a teen/young adult, I was not about to suggest residential or inpatient treatment (though I desperately  needed it), and my parents did not take steps in that direction. This past February, my treatment team suggested I go into the intensive outpatient and/or partial hospitalization program at my treatment center because I was having medical problems, my progress had stalled, and it was clear that I needed more support. My insurance company (through my job as a TA at my university) denied coverage. They also informed me that my mental health benefits were used up. Thankfully, my treatment center figured out how to make this work, and I have been able to consistently see my treatment team.

My current treatment center has shown me e.d. treatment like never before. I have never met treatment providers that are so compassionate and knowledgeable. I have been introduced to the use of DBT (dialectical behavior therapy) in e.d. treatment. I have also been shown that there are treatment providers who will commit to clients for as long as it takes (we don’t even talk about time frames unless I want to), and will do whatever they can to make sure that clients can continue treatment (i.e. reduced payment plans and pro bono appointments for those of us with no insurance or crappy insurance). I now have treatment providers who acknowledge but *never* focus solely the amount of work that I still need to do to recovery. They always focus on the progress that I am making, even as I continue to struggle. I now have treatment providers who refuse to write me off as “chronic” and whose unfailing belief that, not only can I recover, but I can maintain recovery, has helped me begin to believe that myself. My treatment team has shown me what truly unconditional positive regard looks and feels like. They have let me be an active player and collaborator in my treatment process, and they have always treated me like a competent, intelligent, knowledgeable adult, rather than a child who needs treatment decisions to be made for her and who needs to be “educated” about her illness. I could go on and on. And I probably will! But not in this post.

This blog is going to serve a number of purposes. First, I am so delighted and encouraged to see all of the pro-recovery/e.d. awareness blogs out there. When I was working in e.d. education and advocacy a few years ago, this virtual community did not exist. I’m just itching to join the dialogue! I also think that one of the things that sparked my relapse last year was the fact that I pulled out of the activist community both in general, and related to e.d.’s specifically. It’s incredibly difficult to manage graduate school and, well, a life. Grad school does not promote balance. And, yet, balance I must. Being active in the pro-recovery/e.d. awareness world was so important to my recovery. So, this blog is my way of re-entering that.

Also, I am constantly considering the possibility of going into e.d. treatment as a clinician. Obviously this will only happen after a full and sustained recovery on my part. But, my treatment center has really opened my eyes to what a positive and self-affirming experience e.d. treatment can be, and I would like to someday practice based on their model. So, this blog will also give me a space to “theorize,” think, brainstorm, and dialogue with others about eating disorders and their treatment.

This is also my “coming out,” so to speak. Most people in my life know about my eating disorder. However, many do not understand what an ongoing struggle it is. Though I will not be sharing extremely personal treatment details on here, I will not hide the fact that a I am someone with an eating disorder.** Because I am a college instructor and my students could potentially stumble upon this blog, I don’t think it’s appropriate to divulge a lot of personal information. However, it’s time that I “out” myself and stop worrying that someone in my graduate school life might find this and find out I have an eating disorder. While I firmly believe in healthy, professional boundaries, I also believe that there is no shame in having an eating disorder and that it is something that people should not have to hide for fear of stigma, etc. So, here I am!

We’ll see how this goes . . .

** I do have another blog that traces my current recovery/treatment experience much more closely and in detail. It is a “friends only” blog, so you will need a livejournal account to read it. It can be found at