So all of the posting that Laura and Harriet have been doing from the NEDA conference have kind of got me thinking about eating disorder treatment. Namely residential type treatment, but I'll throw others in as well.

I've been in treatment, more times than I'd care to admit. And every time I got out of treatment, I relapsed almost immediately. I'm not unusual. Even though I was blessed with the ability to stay in treatment as long as seven months at one point, I still fell apart the second I was out of someone's watchful eye.

There are several things that I think treatment centers could do better, namely:

1) Help the sufferer take full advantage of all support systems upon discharge. This not only means appropriate aftercare (step-down programs, etc), but also involving friends and family in treatment. This will look much different for a lot of adult sufferers than adolescents, but nonetheless. I think the assumption can be made that people you are close to can and should be of support in helping you fight ED, whether it's giving you accountability for your food plan, being available to chat on the phone, taking you to the movies, helping with transportation issues, etc. Sometimes help will be "stay the bloody hell out of the way." Which is fine.

2) Full weight restoration and cessation of all ED behaviors is essential. I've never been discharged higher than 85% IBW, when I still met all the clinical criteria for anorexia. That's the fast road to a relapse. Your brain won't start healing until your body does. And not only get to your IBW (not the ideal weight that's on a chart- those are often lowball estimates at best. Not always, but pretty damn frequently) but stay there for a while.

3) Relying on "wanting" to get better isn't enough. First of all, you can't want to get better until you realize there's a problem. I was aware, after about 6 months, that I could be diagnosed as anorexic. To me, that was a mere adjective, not a problem. I didn't think I was really anorexic- there were just a bunch of therapists out there covering their asses. So I never wanted to get better because I wasn't sick. Secondly, wanting isn't usually enough. The willing part is important. Letting other people temporarily be in charge. Dealing with the discomfort of eating and weight gain. I didn't want that. I wanted to get better where better=not always feeling like cow dung, but not if it meant eating. Nothing was worth that.

I told Laura this, that clinicians rely too much on pure desire to get a sufferer through the bad days. And that's true, after a time of recovery has already happened. But in the beginning, the fear and anxiety often overpower the desire, or at least co-exist alongside it.

Mostly, I want to get better now. And on the days that I don't, the alternatives of anorexia are so much worse that I'm willing to deal with it.