This is a topic I keep returning to. It’s something that I think about in bed; in the shower; whilst I’m at work, and also something that my therapist asks me every time I see her.
What do I want to achieve?
What are my goals?
This is scary for two reasons. Reason Number One is that I honestly don’t know what I want to achieve, because I’m not sure what I can achieve. Reason Number Two is that whatever I tell myself I want to achieve, my anorexia tells me to shut up and get on with not eating a sandwich.
Added to this, and to complicate matters further, is society’s idea that successful weight restoration equals recovery.
This is true to a certain extent, in that weight restoration (or the process of weight restoration) allows you to begin the emotional process of recovery. It is similar, in some ways, to leaving an abusive relationship: you cannot begin recovering until you have left the relationship, but leaving the relationship does not mean that you are recovered.
When you have been struggling with an eating disorder – or any illness – for a prolonged time-period, it is hard to remember what being ‘well’ feels like, and almost impossible to understand how you’ll get there.
It also seems selfish to aim for complete recovery when I know that that is such a rare actuality for people living with anorexia. Why should I be the one to get better when this decreases the statistical likelihood of complete and enduring remission for people that I care about?
For me, the idea that I can choose to relapse if I want to is a very powerful one. I know that I can lose weight and that I have the ability to be a successful anorexic. For a long time, this was an idea that I struggled with: if I can be good at something, why would I choose to fail? However, I then realised that there is a convergence between the seeming parallels of recovery and relapse: if I am in a position where I can choose illness if I so wish, surely that also means that I am capable of choosing wellness? Very much like when you stand at the edge of a building, your brain often makes it patently obvious that you could choose to jump if you so wished, but you don’t make that choice. You choose to stay alive, but that doesn’t mean that you couldn’t choose to jump. It means that you are in the middle of two possibilities. Not choosing one doesn’t mean that you have failed at it, just that you have not chosen it as the path you want to take.
I had a sudden thought one day this week when teaching English: we aim towards a writing task at the end of every fortnight and then, during the proceeding weeks, we collect the skills needed to achieve that goal. Why, therefore, am I basing my idea of recovery on such skills-based goals? Being physically healthy enough to go to work, for example, is a goal which I have worked towards for quite a long time, and one which I recently achieved. For the first couple of weeks, I felt a glowing sense of pride in what I had managed to do, and basked in the thought that I had met quite a significant goal. However, after a while, this feeling starts to wear off, and my brain tells me that the only way to achieve this sort of feeling again is to become unwell, so that I can once again begin working towards the same goal in order to feel the same sense of achievement. We live in a very goal-orientated society and my whole education has been focused on achieving the next goal. If I have achieved ‘recovery’, do I then have to set myself a goal which goes against that in order to feel the rush of success again? Does that mean that the rest of my life is spent stuck in a cycle of ‘achieving’ recovery and then ‘achieving’ relapse.
Much of eating disorder recovery is based on Cognitive Behavioural Therapy, which advocates finding the link between emotion and behaviour, and then focuses on changing the behaviour. This works well in the first stages of recovery where the main focus needs to be on increasing weight, but there comes a point where I wonder if this is not enough?
Recently, my class has been focusing on writing a fantasy story. For this, the two skills I have isolated as necessary are choosing effective and powerful adjectives, and being able to demarcate speech correctly. However, by the end of the module, what I actually want them to be able to do is to write a fantasy story that is convincing and that they are proud of. This does not mean that I will simply be counting their adjectives and how many times they have used speech correctly: I will be reading their overall piece of work for effectiveness, for the way they have told the story using the skills I have taught them.
In the same way, perhaps I need to use the skills which I have learnt to achieve other things. Maybe I need to find the overall goal that is important to me, and use the skills to achieve that? Theoretically, my life should then become less of a checklist of quantitative achievement and more an unsegmented value-based process: I can be proud of my actions whilst still having an overarching goal which I am working towards.
For those uninitiated in the process of starvation, the link between values and nutrition may seem muddy and unclear. However, starvation removes the ability to have values outside thinness and weight-loss. Nobody who is underweight can have values outside of these things because they are not biologically capable of comprehending them. For example, when underweight, I would have gone out of my way to avoid meeting a friend, even if they were having the worst day of their life, if it meant eating food. From a Cognitive Behavioural point of view, the action aligned with recovery would be to visit the friend and eat the food anyway, working through the negative emotions associated with this in a very insular way. From a values-based recovery perspective, I value my friend and I value kindness and empathy: I would spend time with my friend because I care about her, and the fact that I would have to eat food whilst with her would be a by-product of the fact that I was allowing myself to live according to my morals and beliefs. So I am achieving the food-related goals because they allow me to be the person I want to be, not because somebody else has told me that they’re necessary for recovery.
This is also helpful because this is not a ‘SMART’ target. It cannot be achieved at any one time, although I can achieve actions aligned with the idea of always being a caring and compassionate person. Where I can feel proud of myself, and a sense of achievement, for doing something which is in-line with my idea of what my recovery will enable, I can still strive towards living my life in this way in the future. There is no end-goal, only being the person that I want to be, and this allows me to continue to function.
Although I didn’t realise it at the time, this also helps me to understand other people’s motivation. If a friend who is underweight can’t meet me, it’s not my fault, it’s because their bodyweight doesn’t allow them to see beyond themselves. This isn’t their fault either. Understanding the physiological effects of anorexia on myself, and understanding that it is only now that I have become able to focus on a long-term goal which is consistent with the person that I am has allowed me greater insight and into why other people behave in the way they do and this, in turn, has greatly reduced constant anxiety that I have upset people and self-disdain at my supposed inability to be a good friend.
Of course, what is important is that I understand that I must live inside a framework of compassion. First and foremost, I need to be kind to myself because otherwise I will continue to find myself unable to live by my values. The bottom line is that ethical choices and starvation cannot and do not mix. If I wish to maintain a value of being kind to others, I need to practise this with myself as well. As far as I have found, this is a interdependent process: in order to be kind to other people, I must be kind to myself and, in order to be kind to myself, I must be kind to other people.
The conclusion to this, I think, is that it’s not easy, but it is possible.
Don’t ‘recover’; ‘become’.