Re-parenting Your Loved One; Recovery Stages
Disclaimer: I am not a doctor, I am not a psychologist, I am not a counselor. The best treatment is intensive therapy or a stay in an eating disorder clinic. If there are any contradictions between myself and a professional, side with the professional.
Something just went wrong along the way. Who knows if it was genetic predisposition, the way she was reared, the society she lives in, the girls at school, or the child-molester uncle. It was probably all of the above, in varying combinations. But we can be sure that something just didn’t work over the course of her childhood. So you have to do it again. Literally.
Ana has destroyed your loved one and built her from the ground up to reflect anorexic dogma. Starting all over again, you have to give your loved one a safe harbor to re-teach herself how to be a human being instead of a victim. She has to go through infancy, toddlerhood, adolescence, young adulthood, and finally reach maturity. It’s a grueling journey for her, and in some ways for you as well, but as I understand it the entire process can be achieved within six months to a year, and is certainly worth her life.
Do not rush your loved one through this process, as eager as you are to see her well. She will do this at her own pace, with you gently nudging her along. Everyone varies, and each stage takes different lengths of time.
The following is mostly a summary of Peggy Claude-Pierre’s Montreux recovery program, which you can read more about in her book “The Secret Language of Eating Disorders.” I added several of my own observations.
Infancy
We start with infancy. It may be uncomfortable for you to regard your loved one (who may be a grown woman or man and whom may actually be your equal or your better) as an infant. But consider that even animals know that they have to eat, and you realize that your loved one has missed out on some of the most obvious and primal comprehension of survival, and has for the most part indeed lost her very drive to survive. If she doesn’t know how to care for herself, even though to the outside world she may be a very well-put-together individual, then doesn’t that show that she is quite helpless anyway, and that you are not robbing her of a degree of maturity but are actually giving her the foundations of independence?
Your loved one is helpless against Ana; her actual mind has been more or less consumed, depending on the acuteness of her illness. You have to be her parent who will guard her from the monster under the bed and then teach her to treat Ana with the disdain that any adult would show to the concept of an invisible monster.
Unlike recovery from an addiction, this is not one of those things where the victim has to "choose" or "want" to get better. Every victim wants on some level to get better, but most victims, particularly if they are acutely ill, are incapable of ever choosing to get better since they are not allowed by Ana to express their desire for wellness. If you wait for them to "choose" to get better, you'll soon be waiting alongside a corpse.
Taking the burden of trying to fight off Ana from her will be a great relief to her, although terrifying at first. She wants to be saved, but like a hostage who is afraid to run to her saviors for fear that her captor will shoot her in the back on the way, she is petrified by the retaliation she is sure to bear for cooperating with you. Take the responsibility away from her. Don’t ask her to make decisions based in self-love, because she can’t right now, just as an infant cannot.
During infancy, do what you normally would with any precious baby. Twenty-four hours a day she must be cared for. Feed her, cuddle her, watch her constantly, pull her away from the stove the instant before her curious hand touches the hot range. Protect her from herself. Tell her she’s loved and valued about a thousand times a day (you have to be this repetitive because Ana is just as repetitive in her lies.) Teach her vocabulary -- words and concepts that she doesn’t know or has been forced to forget, things like freedom, self, good, and pizza. Do not hold her responsible for herself or for anyone else.
This is the time to get her physically balanced. She’s not going to be able to retain much therapuetic information if her brain only has three calories to work with. Certainly you can’t get her completely well at this juncture, but get her to consume at least enough to be coherent and not in immediate danger of losing her life. (Be reasonable. Refeeding a starving person with too much food/food that is too rich can actually kill them instantly. Go for slightly more food than she's used to to begin with.) By the way, do not assume that a person has to be emaciated to be in danger of death from an eating disorder. A 400 pound bulimic can die of her disorder, and she has to be taken seriously.
Encourage her to tell you what she hears in her head, and counter everything that’s said (everything, even if you’ve said it several times that day already.) Soon she will voluntarily tell you what she hears, because she’ll want your help in fighting Ana off. Be vocally appreciative of indications of strength and courage such as these.
Expect swift reprisals from Ana. Initially it might almost seem that you are making things worse, because your loved one will attempt to be even more cruel to herself than usual, even going so far as to consider or attempt suicide. Again, this is the importance of round-the-clock care, and also the value of having a two-person team in helping your loved one. (If she does become suicidal and you can’t watch her constantly during this stage you need to consider a suicide watch at the hospital. If she must be hospitalized, brief the staff on what kind of care you expect her to receive.) But remember that you are actually making progress. Ana is simply seeing herself cornered, and like any cornered animal whose existence is threatened she will become even more violent. This is a sign of her desperation and also her weakness, her fear of you and what you’re capable of doing. Tell your loved one this, as it may be of some comfort to her.
The Terrible Twos
Once physically balanced (remember, balanced, not necessarily at a reasonable weight so far), she will be better able to absorb therapy. Make sure that she has a counselor to speak with, and make sure that you are there during counseling sessions.
She will begin to test her boundaries, because Ana demands it, and to see if you are a worthy adversary of Ana, and because she wants to see if your motives for helping her are pure. She hopes that you will enforce boundaries and protect her from Ana. Expect tantrums, watch for her deceptiveness, never show frustration, and always be sure that she understands that you love her and are helping her simply because she’s worthy of being loved. Again, do not show anger, as this will only reinforce Ana’s assertions.
When she wants a different meal plan (not a lower-calorie one, just a different one), it’s a good sign. Involve her in creating a different meal plan, while still maintaining control and explaining why certain things should be included.
Your loved one will tell you more often what she hears in her head. You must continue to offer the same intense argument you used to make against Ana. Make sure that at no point during recovery do you assume that your loved one “knows” that you love her, or that she is good, or that she should eat, or any of these obvious things, even if you say them repeatedly. Ana will break down these building blocks of reality almost as fast as you put them up, so you have to work swiftly and without pause until Ana tires herself.
Cautiously your loved one will try to build an identity. This will be a strange thing for you to watch, as you may never have seen the “real” person under the disorder, and your loved one might not have seen the real person under the disorder either. Like all toddlers, she will take various bits and pieces of different people’s personalities and mannerisms and try them on for size, then just as quickly discard them if they don’t fit properly. I have a closet filled with goth clothes, preppy clothes, glamorous clothes, hippy clothes - you name it, and they changed from one day to the next during this incredibly confusing stage. I’m still a little bit of a mix, but my wardrobe (much like my personality) has taken on a general consistency. Don’t try and hold her back from a particular personality that you’d prefer she doesn’t take on or try to push her towards a certain identity; love her in whatever guise she’s trying on that week, and don’t expect her to stick to it yet.
Take an interest in her opinion. Ask her opinion on world events, on religion, on philosophy, on fashion, on anything. This will help her begin to know herself. Avoid making these discussions into debates in which you try to foist your opinion on her. Just listen, and provide your opinion from time to time just to keep the conversation running. Make every effort to keep the focus on her.
It’s especially important that her home life at this time is very stable, and that you are too. Take very good care of yourself and of your other family relationships to provide a good influence. Don’t give her cause to think that she has to drop her own recovery to take care of you.
Don’t keep her locked up in the house. Take her on outings, always thinking carefully about the suitability of where you’re taking her. The beach, for example, is a bit too much of a body-conscious place at this juncture. Keep her busy with an avalanche of activities and fun.
She will become demanding of your time, your attention, and what she wants. Give all of your time, your attention, and a reasonable amount of what she wants. It’s a part of testing your love, identifying her preferences, and learning to be assertive. For the first time Ana is starting to lose ground and your loved one has a chance to experience some things she’s never been “allowed” to experience before. She’s essentially been locked in a horrific prison under the watch of a sadist for the duration of her illness, and now she’s tasting freedom. So try to be accommodating within reasonable boundaries.
She still needs an authority figure, since she needs a figure stronger than Ana. In a great account in “The Secret Language of Eating Disorders” Peggy speaks of a young man refusing to eat a yam, then asking her if there is no option to eating the yam. Peggy senses that he needs an authority figure higher than Ana, and she replies that no, there is no option to eating the yam. Happily the young man eats the yam, which he wanted all along but needed help fighting against Ana in order to eat. Watch for side-ways pleas for help such as this.
Adolescence
At this stage the actual mind is as strong as the negative mind. The quiet, unassuming nature falls away, revealing general confidence and happiness. Lighten up significantly during this stage, allowing the patient to become more independent and try her wings, while being watchful for back-sliding and constantly supportive as well as encouraging. She will be capable of going out by herself, being alone some of the time, and will even voluntarily eat. You can go out to eat now, but she will continue to want gentle insistence on eating.
She still needs your help, but at this stage for the most part she will tell you when she needs help. The difference between what she once was and what she is now can lull you into thinking that she is cured and no longer needs your help. This would be a great error, and she's afraid that you'll make it. She's afraid that she looks well before she actually is, and is afraid that she will be completely abandoned to her own devices and will relapse. Be sure that you are very watchful but do not hold her back from positive independent actions, and sometimes let her struggle through battles by herself. If she looks as if she's floundering on any single one of these battles, you must step in immediately. She needs to know that you are still behind her and that she is still safe.
If she insists that she no longer needs your help, it's important to remember that this is the arrogance of adolescence. A fifteen-year-old cannot take care of herself even though she might think that she can. Smile and say that you're still going to stick around until she's really totally well, just to be sure.
Her identity will continue to be established, and she will become more expressive in her clothing and will more often assert her opinion. She is very receptive and may ask your opinion quite often. Try to consistently throw the question back at her rather than answering it, so that she can learn to form tastes of her own rather than adopting yours.
You should also allow physical activities more now, but only ones that are fun, only in reasonable doses, and only if she's eating a reasonable amount to fuel these activities. Aerobics probably aren’t fun, but tennis might be for her. This is a great time to encourage her to find other friends, which will help her to develop her identity while simultaneously making her more independent from you.
She will become rebellious, a normal part of adolescence. She will start to shed her constant need to make others happy and will start to take her own preferences into account. This might be hard for you because you're used to her being pliable, but learn to love it, because it's healthy. Treat this growth as you would normal adolescence: with greatly increasing freedoms but solid boundaries that act more as guardrails than restrictions.
Anorexics specifically begin to lose their ambition, which was actually based in the need to please others. Embrace this. If she was an A student and is now a C+ average, accept that her priorities have shifted from you and what you want to her and what she wants. And that's okay, don't try and drive her back into her old passions, otherwise you might give Ana fodder to say "Look, see? They only wanted you when you achieved. You are not good enough."
Young Adulthood
Rarely does a parent throw their kid out of the house the minute they turn eighteen and leave them to sink or swim, even if they seem more or less capable. This is a stage where your loved one is almost completely independent. If she is an adult, she can get a job, have friends, go out to eat by herself, get her own apartment. She can even be of help to more acutely ill eating-disordered persons, and this would probably be good for her and for the other patients, since it can show her how far she’s come and why she doesn’t want to go back, and also because teaching is often the best way to learn. But she always has to feel that she has a safety net, and has to be in constant contact with you, the “parent” to reinforce the lessons she’s learned about her disorder, about herself, and about what reality is. Visit several times a day and talk several times a day. If she starts to stumble, you have to be there instantly to catch her. If left completely on her own, she is likely to flounder if for no other reason than because she feels unsafe without you behind her. She should continue to get therapy during this time.
Adulthood
This is essentially complete wellness. She will always be afflicted with the disease, and it will rear its head at stressful times. But she will be better able to fight it on her own, and will also know when she’s getting too deep in to go it alone. Your responsibility now is basically to assume your normal role, whether that’s spouse, sibling, friend, or parent. You should be respectful of her independence, keep an eye out for trouble, and be generally supportive, just as any friend or relative would. Make sure that as you give up an authoritarian position you don’t also give up the close and binding relationship you’ve created with this loved one. When you see a relapse in the works, reach out to her and let her know that her old safety net is still there. Just knowing that you're still behind her will make all the difference in the world.
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Email: ericaherron@hotmail.com