I Went Through Treatment — Why Aren’t I Recovered?

Posted by on Aug 26, 2014

I’ve been out of treatment for more than two months now. And yet it feels as though I’m no closer to recovery than I was this spring. My therapist and nutritionist have each in turn recommended different groups and programs to try — one of them being Anorexics and Bulimics Anonymous (ABA). I’m at my strongest when I’m among peers, they both reminded me — not isolated.

I’ve attended other kinds of This-or-That Anonymous meetings, but I’ve never been able to connect with the ironclad 12-step model or the insistence on giving oneself over to a “higher power” (albeit, in whatever form you choose). Besides, I reasoned, I’d be starting a new treatment program soon. There would be no need for these meetings.

treatmentUnfortunately, an endless run of obstacles trounced that reasoning: this program doesn’t take my insurance, that program is filled to capacity, another can’t accommodate my work schedule. Since deciding a month ago to rejoin a treatment program, I have yet to join one.

Exasperated, I decided this weekend to finally give ABA a shot. (I hope that’s okay to admit, with ABA being anonymous and all…). On Sunday morning,  I joined seven other twenty-somethings in a tiny, rented space crammed with folding chairs and plastered with motivational signs. At this particular meeting, Ellie*, the longtime leader of the group, was sharing her eating disorder and recovery experiences.

Ellie apparently underwent inpatient treatment years ago at the same facility where I was this winter. The two months she spent there were pivotal, and by the end she gained valuable insight into her eating disorder. But understanding her illness was not enough, she said. Within a day of returning to her stressful home environment, she relapsed.

I thought suddenly of my own doubts about treatment. Months of frustration and fear began to well up. Why was the eating disorder still here? Why was it still so loud? Why, after six consecutive months of intensive treatment, did I still give in to it so easily? Sure, I now had a doctoral-level understanding of how my eating disorder began and where it had left me. But it was still there. I had trekked to the edge of understanding only to find a chasm between recovery and me.

Ellie continued: It took years, but ultimately she landed upon a formula that worked for her: copious outpatient therapy and active involvement in ABA. Later, she began to chair the ABA groups, which offered her further motivation — if she didn’t keep working at her recovery, then how would she be able to serve the other women in the group?

The despondency I’d been feeling lifted a bit. Ellie reminded me of a truth that I routinely forget: Formal treatment simply isn’t enough to get you from partial recovery to full recovery. It isn’t a cure. Something “else” is needed in the process.

Treatment and the “Recovery Gap”

Tina Klaus, blogger friend of mine, articulates this experience — what she calls the “recovery gap” — beautifully. She writes in her post, “Recovery Realities: Completing Treatment is Not Recovery”:

“In my opinion, one of the biggest misconceptions about the role of treatment is that a person is ‘simultaneously being treated for and recovering from their eating disorder.’ The purpose of treatment is to interrupt the patterns, processes and routines of the person’s diseased mind. The intention being that when the time comes to leave the safety and structure of treatment, a person has begun to untangle and separate themselves from their illness and destructive behaviors as they step into recovery. In no way is a person ‘recovering or in recovery’ during this time; in other words treatment gets a person out of the woods but it drops them off at edge of recovery.”

I never assumed I would leave treatment 100% recovered; I did assume that I would at least have found my footing. So when I reached the end and was still enduring the endless call-and-response with my eating disorder, I started to feel discouraged. (And sometimes more in the realm of totally deflated, depressed, enraged, dispirited, despondent…)

Tina and Ellie both point out that there’s an idealistic misconception about eating disorder treatment. Even if we rationally know that it won’t “fix” or “cure” the illness, a part of us hopes that it will, and that hope swells into outright expectation. But the reality is that treatment is only the beginning of a long, arduous process. Beyond the treatment center’s doors are the real-life stressors that fueled our eating disorder behaviors. And let’s face it — away from the watchful eyes of our treatment team and the constant encouragement of our peers, it’s all too easy to return to the familiarity of the eating disorder rather than respond with new, slightly dubious “coping skills.”

Like it or not, however, that’s the next step in the recovery process: taking what you’ve learned in treatment and making it your own. Which brings up the other important point these ladies make. Recovery is ultimately individual. Not alone, mind you—individual. Of course, there are certain commonalties in process: making peace with food, confronting issues that triggered the disorder, and, in some cases, stabilizing weight. But the enigma of “recovery” means different things to different people. For Ellie, it involved a 12-step program and “turning over” her eating disorder to a higher power. (Interestingly, her higher power was a glimpse of unadulterated love that she witnessed in the eyes of a dog.)

A great example of this is Project HEAL’s brilliant “Recovery Is” campaign. It depicts eating disorder survivors holding up one-sentence definition of recovery that each one crafted. “Recovery is using my voice and owning it,” one reads. “Recovery is embracing my quirks,” says another.

Of course, all of this begs the question: What does one do beyond treatment? What is that “something else” that leads to recovery?

The thing is, no one can say what recovery will look like for you, or when you’ll have achieved it (not unlike how no one could truly understand what it was like to have your eating disorder). Fortunately, you’re the only one who needs to understand. There was a day you finally admitted to yourself that you had an eating disorder. There will also be a day when you look back and realize that you’ve overcome it.

I don’t yet know how to get from partial recovery to full recovery. I don’t know whether that “something else” is, for me, another treatment program or a group like ABA. But as Lewis Carroll said, “If you don’t know where you are going, any road will get you there.” Thanks to Ellie and Tina, I at least feel a bit more at ease with the process, a little more patient with myself. Just because I haven’t yet made it beyond the middle ground does not mean that I have failed at recovery. The journey is long, and I’m only halfway through.

*name changed for anonymity

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  1. You write honestly and movingly and I am awed by the courage and persistence that you need. I also see you’re really taking responsibility for yourself – all credit to you.
    Yet as a mother, what strikes me about your story is that the treatment centres that discharge you and expect you to continue on your own are simply not treating to a sufficient standard. If you’d had an operation or a stroke, you would have a post-op rehabilitation program. Physiotherapy, counselling, various outpatient treatments and support groups.
    I hope that treatment centres note what you write and develop their programs to finish off the job. Which would mean either recovery, or tools to live well with certain safeguards in place.
    Until this happens, I wish you and the others in the group much courage and success in finding your own way.

    • Hi Eva,

      Thank you so much reading, and for your comment. To be fair, most treatment centers do work to provide patients with a continuum of care. This involves descending “levels” of care — for instance, a patient will start in a residential center (care 24 hours per day/7 days per week), then most to a partial hospitalization program that runs 5 or 6 days per week for about 5 hours, then to intensive outpatient, which is 3 to 5 nights per week, and finally work only with an outpatient team. This system is great, because it allows you to take increasing amounts of ownership in your recovery, while also providing enough support to make sure you’re doing all right.

      That said, this level system usually ends being the ideal rather than the reality. The prohibitive cost of treatment along with inadequate insurance coverage mean that patients rarely get to spend enough time at each level. And losing structure and support before you’re ready brings with it the threat of relapse.

      So yes, you are right that the current standard of treatment is not sufficient. And unfortunately, that’s the result of many, complex factors. This, I think, is part of the reason why eating disorders are so difficult to recover from.

      Again, thank you for reading and please come back soon!

  2. Joanna I’m glad to hear about that structure, and sorry that the US insurance system is so often an issue.
    I hope today is a lovely one for you.