God Almighty. I need someone to come over here and grab me by the hair and shake me around until my head is cleared of the notion that cleaning out my closet is An Okay Thing To Do during PMS week. The bulk of the clothes have been examined, tried on, cursed at, and separated into piles: dry cleaning; sigh, may as well keep this another year; thank you thank you thank you that you still fit; and get the actual fuck out of my house.
The last pile is the largest, just so you know.
While I was cursing myself, my obstetrician, carbohydrates, skinny jeans, and life in general, I thought about all the blogs and articles I read about recovery. Specifically, full recovery. The notion that full recovery is possible versus the thought that someone with an eating disorder can, at best, hope for a lifetime of management. It's complicated.
Eating disorder expert Sarah Ravin, PhD. defines full recovery in this way:
"…is weight-restored, does not engage in any ED behaviors, has realistic thoughts and behaviors surrounding food, has a realistic body image and accepts her body (even though she may not like it), practices good self-care, engages in proactive relapse prevention, and does not struggle with ED cognitions or emotions. She is cognizant of her underlying predisposition and thus must avoid dieting, fasting, high-stress environments, etc. She may have a better body image, better eating habits, and better psychological functioning than her peers as a result of her treatment." (from an interview with Margarita Tartakovsky, MS)
This is all very good, and plausible, except for that last sentence. Better body image than her peers? I'm going to beg to differ with this to the point of saying it's abject bullshit. Common knowledge in the world of ED treatment is that the body image distortions are the last to go. You dutifully stick to your meal plan until eating doesn't feel so unnatural. You exercise moderately, in a way that honors your body (or at the very least doesn't beat the bejeezus out of it because dammit, you deserve to crawl out of the gym). You ship the itty bitty low rise jeans - or the shapeless, oversized flannely things, pick your poison - off to the thrift shop and replace them with things that both fit and flatter your healthy self. You learn to put yourself out there, you as real and authentic. But in the heat of battle, when you're awake in the middle of the night after making one mistake after the other all day, or when you desperately want to make a good impression, or when you're cleaning out your closet...
You will remember. You will remember your stick-thin arms. You will remember the thighs that didn't touch. That number on that scale. The way people looked at you when you asked the salesgirl for THAT size. No matter that you've forgotten falling down every time you stood up, the complete demise of all your relationships, the weeks locked away. You will put on your rose-colored glasses, and for a while, you will magically grow, rather like Alice in Wonderland. Eat me. Yeah. Because you still aren't capable of seeing what's really there with any consistency. There's no middle ground. Fat or thin, small or large.
But then again, now my body image is supposed to be better than that of my peers.
I prefer Carolyn Costin and Gwen Schubert Grabb's definition of recovery, and you can read more about it in their book, 8 Keys to Recovery from an Eating Disorder: Effective Strategies from Therapeutic Practice and Personal Experience. In this resource, recovery is defined as this:
Being recovered is when the person can accept his or her natural body size and shape and no longer has a self-destructive relationship with food or exercise. When you are recovered, food and weight take a proper perspective in your life, and what you weigh is not more important than who you are; in fact, actual numbers are of little or no importance at all. When recovered, you will not compromise your health or betray your soul to look a certain way, wear a certain size, or reach a certain number on the scale. When you are recovered, you do not use eating disorder behaviors to deal with, distract from, or cope with other problems.
Costin and Grabb highlight the importance of acceptance. My favorite piece of their definition is the idea that, once recovered, you will not betray what you have given blood, sweat, and tears to achieve something superficial. The ED isn't what you do when all hell breaks loose. You are more important to yourself.
So back to the question: is full recovery possible? Costin and Grabb give me better odds of saying yes, because most days, their description of someone who is fully recovered fits me fairly well. I still can't bring myself to say it, though. For me, I think it's a process, and it's a process I have to trust, even now. It would be easy today to make another pot of coffee, skip my lunch, and show myself no mercy on the treadmill. All because I'm angry at some shapeless pieces of fabric. The truth is, whether you want to use the words "fully recovered" or "in recovery" doesn't matter.
And because I wanted to say at least one thing about running....what matters, just like in running, is what you do when the road starts heading uphill. Anybody can run when the road's flat and easy. You learn what you're made of when it isn't.