Perspectives on Eating Disorder Recovery and Relapse

       A thirty-three year old man wrote to me saying he had been a binge eater most of his life and now was fully recovered because food has been a non issue for two years.

       Of course, I am glad he is happy with the strides he has made in his life.  But his post got me to thinking.

       I have been working since 1980 with people who have and who have had eating disorders.  I don't know what people mean by "fully recovered." 

       While it is possible that people can have two years or more of being in a state where food is a "non-issue" that doesn't necessarily mean they are "fully recovered."  By the same token, someone who has not binged or purged for some time and then begins again may actually be signaling growth rather than relapse (although, of course relapse is possible too.)

       As I see it, people develop eating disorders as a way of coping with what they cannot bear.  The people committed to getting well work in psychotherapy, 12 step programs, spiritual programs, nurture their creativity and gain education and skills necessary for them to function as they choose in this world.  As part of this life long process they feel their emotions, recognize and bond with trustworthy people, and develop a sense of self worth.  As they develop they learn and discover how to address their inner and outer life situations without the eating disorder.

       However, as they age, develop, mature, take on new challenges, are confronted with life's strong pleasant and unpleasant surprises, aspects of the eating disorder may return.  If it's not a relapse, (meaning collapse and surrender) it can be a signal that a new strength needs to be developed or that the person is overstretching his capabilities and needs to pace himself. 

       The eating disorder, a tried and true mechanism developed to a person survive, returns to some people not as an enemy but as a guide to teach the person about how they are feeling or not feeling.  The teaching occurs in a language the person understands perhaps better than any other.  TThis is the language of the eating disorder, which for many has been a life long companion.

       In my opinion the "recovered" person, is consciously aware of his or her liaison with the eating disorder.  It's as if the eating disorder were some kind of sleeping general or police force who, when the person takes on more than they can bear, rises up to alert, protect and defend the person using the old eating disorder methods.  This gets the person's attention dramatically.  The "recovered" person recognizes the return of the eating disorder urges or actual behavior as a signal to pay attention to something that is out of conscious awareness. 

       Past recovery work allows the person to reevaluate what's going on in his/her life knowing now that something is being denied. He or she can then do more inner work so they can be fully present for their experience without needing the numbing protection of the eating disorder.

       There can be gaps of five, ten even twenty years of no acting out and then the old faithful protector emerges to wake up a person who is involved in more than she/he can bear and doesn't know it.  The eating disorder lets them know it.  It can last for only a few days and be of tremendous value.

       I would not like people who have occasional psychological informative incidents of their eating disorder symptoms thinking they have lost their recovery.  Nor would I like people who have no symptoms for two years to think that their disorder is over.

       No one knows what challenges life will present in the future.  I doubt that any of us are fully equipped to deal with what the future will reveal.  We all need to keep learning and growing
to survive and thrive in this life.  And we all have signals that let us know we need to learn and grow beyond our current limitations.

       A return of eating disorder urges is one kind of signal that more growth and learning is required.The more recovery work the person has done the more capable he or she is of continuing the recovery work when those inevitable life challenges emerge. Those urges can help open a blind eye or a dulled psyche to a new challenging reality and help a person continue to live a full life.

       What are your perspectives on recovery and relapse?

       Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA bulimia, anorexia, compulsive overeating recovery, www.poppink.com

Comments

[Elizabeth]

Joanna,

I love very much how your work breaks through this dichotomy of sickness / wellness. An eating disorder is something on the order of pneumonia. As you have pointed out, the body can recover while the soul remains ill.

Ultimately, we must heal on all levels, physically, mentally, emotionally, even spiritually.

If the physical symptoms resurface from time to time, often it is to push us to do the deeper work on the other levels.

There is a wonderful book by Jack Kornfield called After the Ecstasy the Laundry that talks about these same issues from a spiritual perspective. There's this myth that once you are enlightened (have had some spiritual insight, have embarked on the path), your struggles are over, when in reality, you go home to the same dirty laundry. The spiritual life, according to Kornfield, has its vicissitudes, periods of confusion, doubt, struggle. The presence of struggle does not invalidate the spiritual experience! So often we think if we are struggling, something about our spiritual experience is not real.

Same with an eating disorder - if we have a bad day, a bad week - after we've been in recovery some time, we question our recovery.

But we shouldn't - that is the good thing about awareness - there is no going back. Once we have these insights, we can't live any longer as we used to.

I did have a relapse of my eating disorder in graduate school. But whereas when I first got sick, I had a lot of denial around my my eating disorder and I resisted therapy and so on, 10 years later, I was in therapy throughout the entire relapse. It was just something I needed while I processed some really harrowing stuff, stuff the whole experience of being in graduate school, studying full time, without the mind-numbing distraction of a job, was bringing up for me.

I do think of myself as fully recovered and I don't mind the language given how eating disordered our culture is. It doesn't mean that it's not a barometer, still, of other stuff going on.

The deep work is unending. I'm learning that in yoga - it never gets easier - rather, the nature of the struggle changes.

Elizabeth

[Joanna Poppink, LMFT]

(My private response is posted with permission because Elizabeth and I thought this conversation might be helpful to others.)

Dear Elizabeth,

Thank you for your eloquent comment. I am glad to hear from you and delighted to post your wonderful words.

I appreciate Jack Kornfield's work as well. I plan on bringing more of mindfulness and Zen into my posts in a few months.

I'm writing you privately because I don't want to edit your words. So I want to check to see if you really meant to write one sentence as you did.

You wrote, "As you have pointed out, the body can recover while the soul remains ill."

Did you mean the body can recover or did you mean to say cannot recover?

I'm fine with posting your words as you wrote them. I just want to be sure that particular sentence is what you meant to say.

Thank you for writing to me. Your words and thoughts, in my opinion, can help many people and in general raise the level of thinking about eating disorders and living well as a full human being.

warm regards,

Joanna

[Elizabeth]

Now I am confused, I think...

I meant to say whereas pneumonia is a physical illness, from which one recovers when the body recovers, a medical doctor could do some kind of test - figure out whether the person is "sick" or "not sick."

With an eating disorder one can regain a state of health in the body - perhaps not at the subtle energetic levels - but one reach a so-called normal weight, or a healthy weight - while remaining emotionally or spiritually vulnerable.

Perhaps it does not make sense? In your clinical experience you have probably seen the opposite - where a woman must recover on the emotional / spiritual levels to let go of the eating disorder. And yes, this was my experience. But I was unusual in that I did not want to get better during those early years. I really, really liked being thin and it was something that was constitutive of my identity. I just gradually let go of it, like a child releases a comfort object, as I healed on other levels.

But now I suppose I am noticing subtle ways in which it persists, despite being quite healthy physically.

I suppose I just don't know what I mean -

other than, as you yourself have said, an eating disorder is a symptom. You can treat the symptom so that the appearance of the disorder goes away (health is restored to the body) but this does not remove the illness, which is something psychological. (I think you said something to this effect?)

I am sorry for this - I did not mean to take up your valuable time.

I am doing some very deep soul searching recently because I have turned out to be a quite horrible mother and my awareness of this is growing and causing me a lot of pain - my yoga practice is bringing it all to the surface and it is creating a kind of "raw" feeling in my body I can't describe.

I have pushed someone away not because I wanted him to go away (the contrary!) but because I did not want to be a burden to him (because my parenting is consuming all of my attention). But I miss him and missing him makes it all worse. Of course I can't call him and tell him that!

I'll be fine, I know, this is a phase - I think you know how painful the "working through" phases can be.

Thank you four kind attentions - I do not expect you to write to me - I know you have a busy practice - this is all most accidental and I do not mean to take your time.

Kind regards,

Elizabeth

[Joanna]

Dear Elizabeth,

I don't believe in accidents. In fact, now that I have written to you and you have responded I think many people would benefit from our beginning conversation.

In my work I've come to realize and appreciate that slight misunderstandings are wonderful. They push people to elaborate more on what they mean. And that pushes both people to think and feel more deeply. When they share more of what they are thinking and feeling the relationship deepens. Both people grow.

With your permission, I'd like to post your original comment, my question to you and this response. I'm certain that many people would benefit from this brief exchange. And who knows? You may get more support and understanding for what you are experiencing now.

What do you say?

warm regards,

Joanna

[Elizabeth]

Of course this is fine, Joanna.

Fondly,

Elizabeth