"No other options"

I stumbled across this story in the UK's Daily Mail ("Emily's mother told her she wasn't welcome at home while she was anorexic") and it really got me thinking. The gist of the article was that Emily's mother said that her anorexia was no longer welcome in her mother's new home. Emily's mother said she had exhausted other options and didn't know what else to do. Most of the commentary I've read about the article usually involves shrill accusations that her mother is a creep, no wonder Emily had anorexia, and so on. That's not really what I'm interested in. What really resonated with me was Emily's response to her mother's ultimatum:

But with her mother's words ringing in her ears and her friends frantic with worry over her emaciated body, in July 2008 she decided to attend an eating disorders clinic as an out-patient.

'I couldn't bear how life was any more,' says Emily. 'I felt there were no other options left.'

And it was that last line, "I felt there were no other options left," that hit home. For me to take the first tentative steps towards recovery, I needed to know that there were no other options for me. I knew that no one on my treatment team or any of my family and friends would support my eating disorder. Just as importantly (or perhaps more so at the time) was that I had exhausted all of my other options. I had done the route of hospital/residential/partial and round and round for years. I had tried ignoring the eating disorder. I had tried various forms of outpatient therapy, support groups, group therapy, online support, you name it. I had tried embracing the eating disorder and trying to make the best of it. In the end, the realization that slammed me and allowed me to start tentatively giving up the eating disorder was realizing that I couldn't have both the life I wanted and the anorexia. I knew anorexia, and the anorexia sucked. That wasn't what I wanted for me.

Last June, my options were limited: keep going with the anorexia and die, or go home and try to get better.

My old therapist is fond of the phrase "choice amongst lack of alternatives." In the early days of refeeding, it meant I got to choose between orange or apple juice at breakfast. If I didn't or couldn't pick, then my mom would pick for me. But there was no getting out of the juice. So I started to make some choices. My recovery was, in a sense, the same way: a choice amongst lack of alternatives. What else was there for me? I had exhausted all my other options and there was nothing left for me to do but get better.

This wasn't a lightbulb moment or an epiphany. In fact, I didn't even realize it for quite some time. Mostly, I felt discouraged and demoralized that I had failed at both life and anorexia. Yet it was the lack of other options that enabled me to start standing up to the eating disorder and begin the process of eating and gaining weight. The idea was so overwhelming and frightening that it literally needed to be the only option for me.

The irony is that this very lack of choice ultimately opened up so many choices for me. I now get to decide what I want to write about, I can pick out what I want to eat, I can conceive of a life that doesn't involve juggling an eating disorder along with everything else.

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Flannery said...

I agree with the mother, actually. What she did is the basic premise of an intervention: you create an artificial 'rock bottom' for the person before they actually hit the real rock bottom, because that one is often death. So the daughter loses her place to live--but not her life. And maybe losing her place to live motivates her to get help--which it did!

Love the person, not the disorder.

I think that the mom, in her turn, ran out of options with which to help her kid. They were both choosing in a dearth of choice.

Interesting post!

Angela E. Gambrel Lackey said...

You have not failed. You have won.

There were other, unthinkable options. And you chose life and recovery. I am so proud of you.

Cathy (UK) said...

The concept of 'tough love' is an interesting one. After 12 years of AN, at age 24, my father wouldn't let me live back at home - because he couldn't bear my AN. I felt devastated and unloved at that point. I had left home with AN and completed three university degrees, and I was still sick.

Tough love didn't work for me. I relapsed further and remained at a very low weight for the next 14 years. I started to gain weight when I really wanted to gain weight, but that weight gain hasn't resolved psychological (and other) difficulties that were pre-dated my AN. However, weight gain has more-or-less cured my AN.

Finding Melissa said...

Thanks for posting this. I can completely empathise with the 'no other choice (aside from death or more pain, which I didn't want) but recovery' scenario; and was also struck by this story, not least as my parents reached a similar point when I hit about 22.

As Flannery writes, "love the person, not the disorder", which is something I have written a bit about on my site (taking the hard line); and, I suppose, in essence, that's the choice: save the eating disorder or save yourself.

Recovery lets you do the latter - and I deeply glad that you chose this route, despite it's difficult nature.

Finding Melissa said...

Thanks for posting this. I can completely empathise with the 'no other choice (aside from death or more pain, which I didn't want) but recovery' scenario; and was also struck by this story, not least as my parents reached a similar point when I hit about 22.

As Flannery writes, "love the person, not the disorder", which is something I have written a bit about on my site (taking the hard line); and, I suppose, in essence, that's the choice: save the eating disorder or save yourself.

Recovery lets you do the latter - and I deeply glad that you chose this route, despite it's difficult nature.

Melissa said...

Wow. I guess that story says something about the shaming of mothers in our culture. I had the same first initial reaction as the commenters. The mother sounds like a horrible person who probably condemned her daughter to death by withdrawing her support, right?
But no, it worked. As the mother probably knew it would all along. Because she knew her own daughter. Of course.
Sorry, that was a little off-topic.

James Clayton said...

"Love the person, not the disorder" rings true and I totally agree that the lack of options - the fact that you're forced to change - can be the crucial push towards recovery.

Anorexia deceives you by getting you to think that it makes things better. When you realise that it stops you doing what you want or will kill you and you're forced to choose between staying as you are or living - that's when you can start to fight against it.

Red said...

I had the same 'tough love' approach handed to me. Mine was a choice between keeping my ED and finishing college. Like Cathy, this backfired. I half-heartedly went into a treatment program and ended up leaving in a worse psychological and physical state than when I entered.

Apparently (and unfortunately) I need to bottom out on my own timeline.

Mamie said...

Just found this blog- it's amazing. And this post is so true. So hard that you have to run out of options and really hit that rock bottom before you start to turn around, but that's how I've found it, too. Thanks for sharing. Mamie x

Amy Girl said...

Hello, I really liked your blog response to that article. I have a question though. My sister is sufering with anorexia, bulemia, and over-exercising. I voice my concerns about her disorder loudly and how I would think the family and mostly her would benefit from professional help. My concerns at this point fall on deaf ears. Am I enabling her because I tolerate her decision not to recieve help at this point?
Thanks for thought provoking blog!

now.is.now said...

Ok, I haven't even finished reading this entry yet, but this line maked (woah. yes, I just wrote "maked" - uh, I mean "made") me CRACK UP:

" I had tried ignoring the eating disorder."

LOL. I laugh because I have tried that strategy so many times - over and over again. WHY DOESN'T THAT WORK?! lol - oh geez... seeing you write it here made me laugh at myself. My general thought pattern has been "Probably I'm making the ED up, so if I ignore it, since it's not real probably, it'll go away." (wait, wait, wait....) "oh. damn. it's still here. WTF!!!"

OK, BACK to reading the rest of the entry now...

Molly Koch said...

I don't agree with tough love. I would NEVER turn my back on my family like that. But I'm glad Emily took it in a more positive way!

Molly Koch said...

And I really liked your response to the article. It is so empowering knowing that you went such great lengths to get your life back.. to realize how each path you took wasn't working for you... so your turned around and tried a different path. I'm really proud of you!

Anonymous said...

this article has given me nightmares. I;m so pleased that it all worked out for Emily, but I'm not at all sure I could do it. It was a huge risk to take, and Emily was "lucky" (yes, the expression needs to have the inverted commas) to have AN rather than BN and to live in a city which has a good ED program. With BN or other EDs there is often no available treatment despite the risk that is almost as high as with AN, and many areas in the UK have no, or very limited, provision for treatment.

IrishUp said...

I think I understand what people are saying if they say "Tough love didn't work for me." But when I read that, it reads like the purpose of setting that kind of boundry is to leverage another person into doing something - like an ultimatum. Insofar as ultimata are really ineffective and likely to backfire in interpersonal relationships, it does not surprise me that "Do this or else" doesn't help someone with ED get better.

But that is NOT what "tough love" is really about. It's about the person saying "because I love you, I cannot help you hurt yourself. Because I love myself (& other affected loved ones), I have to lay this boundry down. This boundry is to protect anyone else from being any more hurt by this disease process, than they absolutely have to be."

Buddhists have an principle that is "Pain is inevitable, suffering is optional." Suffering refers to all the ways our thoughts and behaviors extend and intensify and prolong pain.

Unfortunately, in the situation of the adult ED sufferer (or substance abuser, gambling addict, what have you), there is likely to come a time when the people who love that person need to create boundries to keep the suffering from getting any worse. To keep sanity, finances, marriages, other children from being any worse affected than they already are.

This is NOT turning your back - if it is, then it sure AINT tough love! It is about offering only whatever help actually WILL help that person. It is saying that you will help that person with any and every thing that supports their health and well-being, but you will NOT contribute to their, or your, or anyone else's, suffering in any way shape or form.

When a person or family is considering enacting these kinds of boundries, they are most certainly hoping that it will prove to be the catalyst that moves their loved-one onto the road of health, and away from suffering. But they are also generally desperately trying to hang on to their own. It's incredibly painful, but it's often the only choice that offers any hope of reducing suffering. People facing 'tough love' decisions have endured years of pain. It may not be of the same kind or quality of that of the (ED) sufferer, but this is not a pain-peeing-contest; it's a fact that these diseases hurt the people who love the people who have them.

There is something that reads very selfishly to me in the sentiment that tough love "didn't work" or "you should never turn your back on...". It's like telling the friends and family that they were jerks, or false friends, or bad mommies and daddies. It erases how painful the events leading up to such decisions are. It is another way to reframe the control-trope; families do this to control the behavior of the (now adult) kid. It ignores the fact that, at the end of the day, it's wrong to tell someone they have to hurt themselves to prove that they love someone else.

I'm sorry, this touches home, as it is something that has happened in my family (tho thankfully, not in the realm of ED).
I did want to point out that "Tough Love" is NOT about manipulation, it's about preservation.

And the converse applies - it is ABSOLUTELY wrong for loved ones to believe (though understandible if they sometimes *feel*) that if the person isn't now "choosing" to get better, it means that person is bad, or doesn't love them or whatever. It just means that the disease process is really really powerful. Tough love can't be about the manipulation or guilt, it has to be about standing ready to help while being poised to avoid further harm.

IrishUp said...

@Cathy UK;
In rereading my comment above, I sound pretty critical of your comment and I am sorry, I didn't intend for it to come out that way. That's not how I feel about it - or you - at all. It didn't work for the person I allude to either, and that just makes me super-sad. She had a very tough time for quite a few more years before she was able to put the brakes on it, and work her way back towards health. I'm sad b/c I know that she must have endured a lot, being that sick and away from us.

I was trying to isolate and critique the POV that many have that "tough love" is to boundary setting as the "food police" is to refeeding. You know, like it's a power-struggle move, not a protective stance. I didn't do a very good job of that.

And I am very sure some people have experienced parents or care-givers who were abusive, and did reject them out right. I think that's terrible, and I hope I could never do such a thing to anyone, much less someone I love. I hate that people have lived through and with that kind of thing.

Anyway, I hope my post still managed to provide some insight for those who've been blessed to not have to face that choice.

Sorry for the tome.

marcella said...

Irish - thank you for your thoughts which have made me analyse my own response (the one above yours).
I do think that sometimes the system in which these actions by individuals are played out matters a lot. The circumstances of the article are literally very close to home for me. I have stood in Oxford High Street watching so many obviously sick students with a huge desire to buy a placard saying "Eating Disorders Clinic this way". However if I had done, or if anyone else had performed a mass intervention, the service would have been swamped and that would only have been with the obviously sick individuals. There's be no room for the bulimic or those with compulsive over eating who are already discriminated against in terms of access to treatment.
As is usual with such articles, there is very little about the actual treatment in this. We hear that Emily's therapist told her that if she gained weight her OCD thoughts would disappear, and low and behold they did, and she got a boyfriend, and all was well. Was it that simple? You bet it wasn't. I'm SURE that Emily found it incredibly difficult, had times when she wanted to give up, had times when she needed a lot more than 50 minutes a week support, had times when her friends needed to step in and provide a more "parenting" role, had times when she hated the ED service for what she was going through. She made it, and for that I truly rejoice, but I'm still not sure that I could take the decision her mother did.

Anonymous said...

Sorry to go on about this one, but it is genuninely giving me nightmares!
I guess what I mean to say is that the success of such interventions will depend not only on the individuals involved, but on the availability and suitability of treatment on offer - Marcella

Laura Collins said...

I don't like the term "tough love" and I don't like the "did it work?" question. I am a fan of parents making a clear boundary and saying "I love YOU and will support your treatment." You can call that what you want, but I call it withdrawing support for the eating disorder.

I don't think these boundaries should be judged by whether it "works" or not. We can only do what we have the power to do.I don't consider that tough love, but just love.

Anonymous said...

Hi Carrie, Just wondered if you had seen this: http://www.guardian.co.uk/commentisfree/2010/apr/14/anorexia-eating-disorders-parenting

Same people, much better article (in my opinion), thank you x

marcella said...

Thank you SO much for this anonymous. I'm going to sleep tonight! Oh the difference between the Guardian and the Daily Mail.

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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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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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