Why food isn't enough

I think I've expressed my opinions frequently about the role of food in eating disorder recovery. You need to eat first. Before anything else. Before everything else. Because life isn't all that fun when you're starving. You can't solve problems very well with a malnourished brain.

Food is medicine.

One of my classmates had strep throat a month or two ago, did her week-long course of antibiotics, and recovered just fine. Penicillin was her medicine. But her immune system also had a role in this- gobbling up the dead bacteria, modulating all of the chemical signals that might otherwise have sent her into shock, keeping her cells in balance.

Penicillin was her medicine. Food was mine. But penicillin wasn't enough for her. And food wasn't enough for me.

Yet another tale. I met a woman (S) shortly after I was first diagnosed with anorexia back in 2001. We were in the same support group and quickly became good friends. Although she was in her mid-30s at the time, this wasn't her first bout with an eating disorder. When she was in high school, she also suffered from AN, somewhat briefly. Long enough and bad enough to meet the official diagnosis, but eating disorders weren't on people's radar screens back in the mid-80s the way they are now. She had siblings with mental health issues of their own, as well. But soon she was home sick from school for an extended period of time, and her mom, she said, made her eat.

And her eating disorder did go away. For a time. Yet 15 years later, the old behaviors came creeping back.

Some who criticize the Maudsley Approach, which treats food as medicine, might say that this means eating disorders really aren't about food. If they were, my friend S should have been cured.


My guess is this (I haven't asked S about it, so I can't say for sure): S quelled the AN voice by promising that this eating, this indulgence, this gluttony, was only temporary. Soon enough, she might have said, I will be back with you.

It's what I said every time I was in treatment. Obviously, I knew I had to eat in the hospital. I didn't like it (especially because the food sucked), but I did it. Part of it was the grim inevitability of it all: eat or be tubed. Yet it was easier than doing it at home, and not just because of the support. It was easier because I knew it was temporary. I'll use the damn butter, drink the whole milk, eat the pizza but only while I'm here. When I got home, I knew I would go back to my old habits.

When I began eating at home, it was harder mentally because I knew there was no getting out of it. I would have to start making peace with butter, because it wasn't going anywhere.

Part of the difference between S and I was that I had a diagnosis. I had support. She did not. S didn't know the cruel voice was anorexia, and she didn't know how to fight it. She didn't learn how to nourish her body properly, even when her brain was telling her to starve. And she didn't have to face the inevitability of butter.

That might be, in part, why bringing my recovery home was so important: I learned to survive the peaks of anxiety. I rode the waves and survived. The butter itself was more important than just a source of much needed fat. It was the knowledge that I could eat it and life would go on.

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Anonymous said...

How did you embrace butter, on your own ... at home, the time it finally worked? What was different when you went home for the last time? Did you have different structure? Had your mindset changed enough that you just steeled yourself and white-knuckled your way through? Did you have loved ones "forcing" you to accountability? You are so right about this part being the crucial difference, especially for those who don't have the option of PHP or IOP. I don't have a "google/blogger" identity, but I found my way here via SomethingFishy. Take good care.

Anonymous said...

I think you are so right about all this, Carrie. Getting back to a healthy weight and normalizing eating in the patient's "natural habitat" is just the first step. Helping the recovering person take on independent eating in the midst of their ordinary stressful lives comes next, then taking on whatever remaining issues get in the way of a healthy, happy life (no doubt this varies a lot from person to person.)

Even in the earliest (refeeding) part of treatment externalizing the illness and offering compassionate support are important psychological components of FBT. It really sets the stage for later on. Seems to me the beginning part of FBT focuses on externalizing the bad stuff and the later part focuses on internalizing the good stuff, along with managing everyday difficulties. Your post yesterday expressed really well how important that is (and you were so much more articulate than I am--"bad stuff", "good stuff"--what the heck?)

I'm as pro-food as they come, but it's not the whole story. I agree wholeheartedly with le Grange and Lock when they say, "Weight restoration alone is not sufficient for recovery." Starving people need food--that's a no brainer--but recovery for AN takes more than that. I think the food part of FBT receives so much attention since it's the main contrast point with more usual treatments, but the rest is just as important.

Laura Collins said...


You speak the truth from a perspective of inside and outside the illness - and it is invaluable.

I look forward to the day when people stop framing the issue as "food" vs. psychological approaches. Both are necessary but not sufficient. I work hard to convince people that the food is not optional - but only because people already assume the psychological work is necessary.

We've got to see these aspects as working together. Otherwise we are engaging in the sort of black/white, good/bad, all or nothing thinking that complicates recovery.

TryingtoCare said...

I really needed to read this today

A said...

True true true,

But I have the same question as anon.

I used the same excuses as you in treatment Carrie, and now I am paying for it. . .

How did you take initiative and accept recovery for itself -- as opposed to a temporary measure?


carrie said...

How I embraced butter...

Hmmm. I didn't do it randomly or voluntarily. It was stay at home or go back IP- and I had just left 7 months of residential. The thought wasn't appealing. And hospital food sucks.

I guess I embraced it more (opened my arms wider, perhaps) after I overdosed and wound up back on the psych unit regardless. After realizing I had just wasted my 20s, that I had no money left for more treatment, I basically just said "f*ck it."

I struggle every day with wanting to throw the butter out the window. It's not over. What keeps me going? I don't know. Every day it's different. Mostly, it's new friends and relationships I have, and not wanting to leave my kitty again. Nothing earth shattering, but it keeps me real and keeps me grounded.

Spider63 said...

Butter is great on toast!

carrie said...

Toast with just butter is fantastic. I think part of the reason I like it is that it reminds me of living in Scotland, and I would have that every morning with breakfast.

A said...

I can understand that --

I wish I had your maturity in terms of my ED.

But in terms of recovery, are you weight stable now or still underweight? Are you completely asymptomatic?

Just wondering as many people I have met in treatment now claim to be recovered at BMI's below 20 and still have ED behaviours.

It kind of confuses me when people define recovery in different ways. Is it just "eating scary foods" and "being OK with yourself" or also being weight restored etc. . .

It's just confusing.


carrie said...

I think some of the maturity is hard-earned. :) I'm approaching 30 quite rapidly and the realization that I didn't remember most of my 20s because of the haze of anorexia was quite sobering.

And my BMI is definitely above 20. Still well within whatever they define as "normal weight," but I was never a midget.

Am I completely asymptomatic? Oh believe me, I have my moments. I'm not perfect. At all. Eating is still a struggle. The main reason it's gotten easier is that I've gotten used to eating.

Part of what recovery will look like for you might depend on what things were like before the eating disorder. I was always obsessive and perfectionistic. Some people just got to enjoy that fun while they were ill. So for them to shoot for freedom from those thoughts and behaviors is realisitc. It isn't for me. Recovery will be when I can manage them better. And so on.

A:) said...

Thank you Carrie, that was helpful. It's nice to know you have a realistic view of what the recovery journey is like.

I think I will be like you in terms of my recovery -- perfectionism, obsessiveness, etc was part of my personality before the onset of my disorder. . .

Very likely I will have to learn to manage these traits without resorting to starvation.

Getting used to eating again really is a process, and as you said in the post above, it is a dance.


Anonymous said...

I've never commented here before (found you through Rachel at The F Word) but had to respond here and say PREACH IT, SISTER.

I think if recovery's going to stick, it has to be integrated into the person's normal life. That requires learning how to eat healthfully on your own, and also requires identifying and addressing the factors in normal life that drive ED thoughts/behavior. (Unfortunately, in my experience, this part of the process can take a lot longer than weight restoration. It only makes it harder when friends and family don't realize that I'm not done recovering just because my eating and weight are back to normal.)

Unfortunately, I disagree with the poster above who said that people already realize that recovery requires psychological work. Some Maudsley supporters (who seem to be largely parents of ED patients, not the patients themselves) don't seem to get it. There have been some egregious examples in the press lately, and it makes me really nervous to see the just-tie-her-down-and-feed-her-a-milkshake attitude given this veneer of science. Can't we get a little respect?

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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Have any questions or comments about this blog? Feel free to email me at carrie@edbites.com

nour·ish: (v); to sustain with food or nutriment; supply with what is necessary for life, health, and growth; to cherish, foster, keep alive; to strengthen, build up, or promote


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