The half-baked cake

A few weeks ago, I heard of a girl named Sofia Benbahmed who was trying to raise money so that she could get the treatment she needs and deserves to fight her eating disorder. Her insurance company won't pay for the long-term treatment Sofia needs to get well, and so bloggers are taking turns sharing Sofia's story to help raise money for her treatment.  You can donate (tax deductible) to Sofia's care here.

As I sat down to write something for Sofia's fund, I realized I had already written what I wanted to say.  So here's my metaphor for eating disorders and the need for long-term care: The Half-Baked Cake.

When I was at the Congressional Briefing following the EDC Lobby Day last April, I heard the clinical director of the Renfrew Center in Bethesda, MD speak. Mainly she spoke about how managed care has dramatically changed the treatment of eating disorders--and not for the better. One of her comments really hit home with me, when she said (approximately) the following:

Normally, you look in a cookbook for how long to bake a cake, and the recipe says to bake at 350 degrees for an hour. Managed care operates under the premises that you can make the cake at 500 degrees for 20 minutes and still have a finished cake. The irony is that often the cake looks done on the outside, but the inside is still completely raw. And if you let the cake sit for any length of time, the uncooked interior causes the whole cake to collapse.

The parallels to eating disorders are obvious: as soon as you start to "look" or outwardly seem better (i.e., the outside of the cake looks baked), the heat is turned off, the support is removed, and the whole thing collapses because it can't yet support itself. The analogy transcends issues related to managed care and really has to do with how we view eating disorders.

We need to start seeing the initial phase of weight restoration and normalization of eating behaviors similar to detox from addictions--it's a necessary first step but far far from the last. Furthermore, intensive, ongoing support is still needed after detox and weight restoration so that brain healing can take place and the person can learn how to overcome their tendency towards substance abuse or eating disorders.

Although the Renfrew director and I differ on why care needs to be continued after initial weight restoration (for her, it's the need to address the root cause of the eating disorder; for me, it's the need to allow ongoing brain healing and begin to learn and use better skills to deal with life), I do agree with her on the priority of weight restoration and the need for intensive support long after you start to look "better."

Maintaining a healthy weight is still hard for me. I have made huge strides, yes, and the higher weight has (I think) really helped to start to cement some of my recovery in my brain. (I kind of wish it didn't, but there you have it.) But I still need a LOT of therapy to help me learn to turn off that knee-jerk response of lose weight-restrict-control-control-control that my brain seems to have when faced with basically any kind of stress. My perfectionism is alive and well--perhaps because I can't bury it exactly six feet under. And the body dysmorphia? Well, let's just say that my mom's suggestion of a soak in our jetted tub to recover from Lobby Day was nice but almost laughable because I close my eyes when I shower so I can avoid seeing myself. A bath is totally out of the question.

My cake isn't fully baked yet, no matter how good the outside looks. I don't blame people for getting impatient- heck, I'm getting impatient. But the cake needs to stay in the oven and my therapy and support need to remain in place until the cake is baked.

And then I'll probably have to frost the damn thing.

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8 comments:

Danielle said...

Hey.. that actually makes a lot of sense. Someone could be barely eating, but they could be dying on the inside without realizing it. And then we try to get better. We gain all the weight back. Everyone thinks- hey they're gaining weight. They must be better. Wrong, we're still a bit messed up on the inside. Thanks for posting this.

Anonymous said...

i understand exactly where you're coming from - the amount of times i've been in inpatient treatment where their sole aim is to get you to gain weight. they all say 'it's not about the food', but when it comes down to it, that's all they focus on - is it any wonder i relapsed each time? the unit i went to seemed to have this theory that if you could get to BMI20, then you would automatically be cured - because you were facing 'every anorexics fear' - a healthy weight. for me inparticular, my other problems only worsen when i gain. luckily though, here in the uk we dont have quite as many problems with getting funding for ip treatment.

Loriana said...

What a great analogy! Recovery truly is an ongoing process with no way to determine when it "ends" for anyone.

Jeanne said...

Same goes for those whose outsides never looked unbaked. (those with ED-NOS.)

Jane said...

Frosting might be the fun part. You never know.

Susy said...

I can really relate to that analogy and that is exactly what happened for me. Even I started to believe I might be fully baked but then I felt myself collapsing and felt like I had no power to put myself back in the oven so to speak :P Thanks for being real and talking about your body dysmorphia after weight restoration. It's inspiring that you feel that discomfort and STILL don't revert to old behaviours.

missmarymax said...

Thank SO MUCH for this post. I love the cake metaphor. Just a quick clarification: Donations to Sofia's fund through the GiveForward site are actually not tax-deductible. However, you can also donate through the FREED foudnation - and that IS. To make a tax-deductible donation, just send a check made out to "the FREED foundation" with "for Sofia Benbahmed's treatment" written in the memo box to the following address: PO Box 4113 All funds (donated through the site or through FREED) will go directly to Sofia's care.
Warren, NJ 07059

Cate said...

My cake isn't baked yet either...but unfortunately the outside still looks really crap too. ED really really really bites doesn't it

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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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