Ways of a Warrior
by Monika H. Ostroff
Step One:
The whole world seems to want to know how to convince an active anorexic or bulimic person to gain control of her (his) behaviors around food. Everyone seems to have a different opinion on the matter, and of course, they all think that they are right. This phenomenon is something I found incredibly frustrating while I was searching for answers during my own lengthy and grueling battle with an eating disorder. It is true that every individual is unique, each individual's struggle with his or her eating disorder is unique, and each person's process through takes its own time. I found that accepting those facts made my own struggle a little more tolerable. What worked for other people did not necessarily work for, or even help me. Essentially I had to take absolutely everything that felt like it might work and try them all. At times, because the very nature of healing is painful and difficult in and of itself, I found it helpful to think of the road to recovery as the path of a warrior. I would like to share with you some of the concrete things I did that were tremendously useful to me in my recovery. These were things I knew in my heart would be helpful to me, and it was my heart I followed even when I was met with resistance. I did not wait to master one element before moving on to the next; I worked on all of them at the same time. And while working on these elements simultaneously, I was also working on learning to both love myself and treat myself with gentleness and compassion. I urge you, in your own process, to be gentle with yourself and allow yourself whatever time you need to heal.
Holding onto hope is crucial, but I also know that is far from easy. There were plenty of times I felt as though I'd lost hope, everything looked bleak, and I was certain I was living at the bottom of some very deep, black pit. But hope is always there; it's just that sometimes you need help seeing it. Each one of you has it --- your hope is there. How do I know? You wouldn't be reading this and you wouldn't have even picked it up if you truly did not have one ounce of hope in you. You would not be in therapy, you would not be in an eating disorders program, and you would not have even taken the time to listen to me speak. Do you see what I mean? The very fact that you are trying, the very fact that you are showing up for your treatment, and reading and searching for answers is proof that somewhere inside yourself is the light of hope.
What is hope anyway? Sometimes its very definition seems elusive and out of reach. Hope is believing in the light at the end of the tunnel even when you cannot see it. It is holding on to the belief that things will get better even when you have no idea on earth how that is possible.
During my own struggle I often searched for hope that was concrete. I was desperate to know for sure that recovery was possible and attainable. The concrete hope I found often did not feel very hopeful at all. It came in the form of modern medications like Prozac or techniques taught in cognitive behavioral therapy. It came from a lot of people who were asymptomatic and proclaiming themselves to be recovered, despite the fact that they were still plagued by obsessive thoughts around food and fear of the dreaded scale. My problem was that I wanted more than just medicine and a life of symptom management. I wanted to be back to the way I was before I ever became chained in the prison of anorexia and bulimia. People working with me told me that was impossible. In fact, they said I would be lucky to even reach a place where I could manage my symptoms. I was in and out of programs for six years and heard the same thing: "You will never recover to the point you are talking about, Monika, but someday it may be more in perspective." That was maybe the nicest and most hopeful thing I heard.
What I can tell you today is --- they were all wrong. I am back to the way I was before I ever even knew what a calorie was. I can assure you all that a full recovery is both possible and attainable for everyone. There really is a light at the end of that tunnel. I lived in darkness for most of my life and could not see it either, but it is there. And I know you can find it too, just keep believing in it.
The very first thing that I had to do was be willing. I'm not talking about willpower; I'm talking about willing. You can have all the willpower in the world and it probably won't do you any good in battling the demons of your eating disorder. Being willing and open to trying new things, while sitting with the fear and discomfort they inevitably bring is the biggest and most important step you can take. I am not saying it is an easy step, but I will never discount its importance. Keep the words "willing" and "open" in mind as you read through this.
Although it did not happen often enough, being exposed to and spending time with someone who has fully recovered was invaluable to me. It was so helpful to spend time with someone who did not watch everything she ate, who did not have to compensate for eating butter by skipping her next meal, purging, or running two extra miles. It was really nice to be with someone who could throw a pat of butter on her potato with the same ease that I drank water. It was comforting to be in the presence of someone who was not tortured by obsessive thoughts and rigid rules around food and weight, but who knew exactly what that felt like. There was something very reassuring about it. Perhaps because it was like looking hope directly in the eye. This person had been as bad off as I was, and there she was sitting in front of me and she was really OK.
I used to beg program directors (of the programs I was in) to have a recovered person comes in on a regular basis. It felt so helpful to be able to ask questions, and have someone model the very behavior and new ways of thinking I was trying so hard to acquire. Although that never did happen, I did manage to find two recovered people to talk to intermittently. Spending time with people who were taking care of themselves and practicing healthy behavior was crucial for me when I was giving up my own self-destructive ways. These people could reinforce my new behavior and help me to feel okay about it. I also had to limit the time I spent with people who were more ambivalent about recovery than I was. Being around people who were still heavily engaged in starving and purging, while I was arduously trying to stop doing those things, was incredibly provocative. I found that if I only spent time with them, or if I spent the majority of my time with them, I would inevitably slide backwards. Perhaps because their acting-out reinforced my old system of beliefs and behaviors. I did not cut off relationships with anyone, I was simply more careful about how I spent my time.
Keeping an extensive goals notebook in addition to my journal was one thing I decided to do on my own, and which I found to be very helpful. Each day I would have between three and five goals, along with the strategies I would use to try to reach them. At the end of the day I would process the results in writing. For example, my first goal was to confront the 'warped thoughts and rules' I had around food. My strategy was to write them all down (or at least as many as I could think of) and then immediately following each one I would write an argument refuting it. In the results section I wrote about whether or not any of my beliefs changed, whether or not I felt any differently --- more or less fearful, etc. This particular goal took up about five pages, but on average I would say each day took up about three pages of notebook paper. I had to really push myself to follow through with this, and honestly it was a tremendous amount of work on my own. Should you decide to do this, it would be helpful if you could find someone to go over your notebook and process your goals with you on a one-to-one basis. Having someone be consistent with you will help you stay committed and motivated (at least it would have helped me). The rest of what you will read appeared in one form or another in my goals notebook.
Confronting fears directly related to my eating disorder was fundamental. This wasn't the easiest thing for me to do, because I felt really 'stupid' about even having some of these fears. Although they were very real to me, the thought of actually admitting them and saying them to someone felt incredibly embarrassing and uncomfortable --- Not to mention the fact that I had to fight to even be able to talk about them. Usually, every time I would find the courage to bring one up, group leaders would invariably say, "The food is not the issue," or "It's not the weight, it's what is behind the weight," and then they would refuse to allow any further discussion on the matter. It happened even in one-to-one situations. And while statements such as "it's what's behind the eating disorder" are true, they perpetually overlook the fact that the concrete fears stemming from the eating disorder are real, and deserve the time to be processed as well. There has to be room for both the underlying issues and the direct fears. The premise that the fears surrounding the food and weight will 'go away all by themselves' once you deal with the 'other' issues is simply not true. I know --- I've tried.
It made sense to me to confront my food related fears head on, and that is exactly what I did.* For example (and I'll give you a couple), in the process of restoring my weight I became terrified that I would never stop gaining weight. I watched the scale go up, and up, and up, and, well, you get the picture. Initially I was too embarrassed to even say this in a group. So, one day in the parking lot I sheepishly mentioned it to a friend. I said, "You know, I keep thinking I'm never going to stop gaining weight and I think I'm going to explode into shrapnel." My friend squinted at me and asked," What's shrapnel?" I replied, " It's what the fragments of a bomb are called after the bomb explodes." Suddenly she burst out, " Oh my God! That's IT!!! That is exactly what I think too!" I felt so relieved to know that I was not alone in this fear. Thinking that maybe there were even more people who felt this way and were also too embarrassed to talk about it, made me decide to bring it up in a group the next day. There were a lot of nods and looks of recognition on the faces of the group members, which told me that they knew exactly what I was talking about. The particular group facilitator was less than pleased with me for introducing this topic, but it turned out to be a useful, comforting experience. Although it may have sounded silly to anyone listening in, it helped all of us to be able to say things like, "Well, I've never really heard of anyone actually 'exploding' while recovering from anorexia and bulimia ... have you?" Another person answered, "Well, no. I haven't heard of anyone spontaneously combusting from eating and, you know, if that had happened it would have been in the Enquirer!" That comment evoked plenty of laugher! Voicing this fear (or any other fear be it about candy, sugar, fat etc.-no matter how embarrassing or silly it feels) to a group of empathic listeners and working through it together is a very valuable experience. It also proved to be beneficial to raise these same fears with a recovered person, because they could confirm that they had feared the same things and they are living proof that the fears are just that: fears. They do not materialize. The nice thing is, later on when it comes up again and you are alone --- you can take solace in remembering the conversation in the group, the conversation with the person who is recovered, and the fact that you are really not alone at all.
Asking questions about basic concepts that I could not grasp was another uncomfortable, but necessary aspect of my recovery. A good example of this is the whole concept of: 'everything is fine in moderation.' I remember thinking, "moderation ... what the hell is that? I know it's somewhere in between the end cut of a grape and ten pounds of them." I'm sure you can see how unhelpful my knowing that was! I was always too embarrassed to ask, and when I did finally muster up the courage to ask, the person I asked would simply remind me that I have a high IQ. ( Incidentally, d I never did figure out --- despite my high IQ-how that was an answer to my question!) I eventually learned the concept of moderation by repeating this question time and again, insisting that I really did not know what it meant. Finally I explained that because I was accustomed to going for very long periods with very little if any food and alternate periods of consuming a lot of food and then purging it, it was only logical that the whole concept of moderation escaped me. Presenting it in this way forced the people working with me to see how it was possible for a concept so simple to become so complicated. They eventually began to help me understand it.
I also needed the answer to the infamous question: "when was my stomach going to go down?" I never wanted to ask anyone this question; I never really wanted to draw attention to the part of my body that I was most sensitive about. When I did ask, people would insist that my stomach was not sticking out, even though I could see quite clearly that it was. And it was awful because it used to make me panic. It made me look and feel fat, and I was terrified that it would never look normal or be acceptable to me again. Frankly, I couldn't find anyone very sympathetic to this issue. When I would rather sheepishly inquire about the plight of my stomach, I had a lot of people say to me, "well, I'm not sure a woman's stomach is supposed to be flat." I would argue that that wasn't exactly an answer to a question that I was really rather frantic about. I wound up finding out inadvertently from a doctor I didn't know very well. Let me share with you what I found out and what my experience was.
Of course, the size and shape of our stomachs change right after we eat. It gets rounder and larger until the food digests, and then it goes back down. For me, it wasn't returning to normal. That was because having had my eating disorder for as long as I did, my entire digestive tract was sluggish. My entire system was so unaccustomed to digesting food, it needed to literally relearn how to do that. I needed medication to help my stomach and intestines start contracting again (I should add not many people this medication). I discovered that it could take between one and two years for my digestive tract to function normally on its own. It took my stomach a couple of months to go down, and actually a couple of months is quite average for most people. I know, you think that sounds terrible. I thought so, too, at the time. But on the other hand, I was really glad to know it would take that long. Knowing meant that I could stop panicking about it on an hourly basis or acting out in my eating disorder in an attempt to change it. I had to resign myself to just sitting with it and not acting on impulses which would bring me temporary relief. I had to just go through it. Although this was uncomfortable, it was doable. Knowing how long it would take allowed me to reassure myself, "it isn't supposed to go down yet, it hasn't been a couple of months. I'm not fat --- everything is just trying to adjust to taking in food again. It takes time; it will be normal." During that time I found a lot of things to say to soothe myself and calm my fears. And yes it did go down; it was true. It is normal. I don't even think about it or pay any attention to it at all anymore.
It was equally important to talk about how my changing body affected me. This was really hard. My body was filling out and I was getting a lot of unwelcome and unwanted attention from men I didn't know. That was a big problem for me, mostly because I have an extensive and severe history of physical and sexual abuse. As my body changed, and as I got more attention, I began experiencing a realm of difficult feelings. For some reason, I became even more convinced that the abuse was all my fault and that I really was a terrible person. I felt a lot of shame and I felt dirty. It felt, overall, very unsafe to be in my body. I found myself afraid of being assaulted again. And none of this felt okay to talk about. It was uncomfortable, embarrassing, and mostly I just wanted to crawl under a chair. I thought people would misunderstand me and think I was being conceited --- because I was getting this attention from men. But my reality was that I was so terrified and so ashamed. Talking about it felt terrifying too, and it even momentarily increased my shame. But I was willing to try and willing to endure the difficult feelings and discomfort that came along with it. I found that sometimes just naming what is happening, even though it cannot be 'fixed' helps.
This was also a time when I had to look at the fact that my way of protecting myself (by staying underweight and unattractive) was also hurting me. I could see that something that is simultaneously protective and hurtful was a contradiction in terms and did not make sense. I began to wonder aloud if there was another way to learn to protect myself. I found that there are other ways. People can help you feel safer in your body, but you have to be willing to endure the discomfort of talking about it. You have to be open to trying some of their suggestions, and you have to risk being vulnerable. It was very difficult for me to allow myself to be vulnerable. Once you have been hurt so terribly, risking being hurt again --- although in a different way-was both frightening and worth it.
By now you can see the theme of learning to just "be" and sit with discomfort without frantically trying to alter it. At times I would purposefully put myself in situations that made me anxious. I would take risks and eat something that I thought was terrifying. Take for example, chocolate. I would eat it and then I would panic. I worried about it making me fat; I worried about all sorts of things. I tried to figure out how I could skip dinner to compensate; I thought about purging it; I thought of many 'remedies'. after five or so minutes of panicking and frantically trying to figure out what I could do to fix or undo it I would say, " WHO CARES??!! IT'S JUST A CANDY BAR! One candy bar, so what?!?!" Then I would force myself to divert my attention to something else. I would make myself stop panicking and worrying. Sometimes it helped to recall that my recovered friends ate those foods all the time and they were not fat. I forced myself to let it go and refused to act on impulses to skip a meal or purge. While this may sound bizarre, it was most helpful. Perhaps because I did it on my own accord with no one forcing me to. I did this because it was important to me to have a varied diet, one that looked more like the diets of those who have never had an eating disorder. I longed to be able to go anywhere and eat anything without obsessing, panicking or driving the people I was with crazy. Doing this not only helped me to reach that point, but it was instrumental in diminishing my urges to purge as well. In fact, not too long after engaging in this practice my urges to purge disappeared entirely!
I also had to figure out how to work with my ambivalence, because frankly there were times when I just didn't want to recover. and keeping my eating disorder was just fine with me. I began by vowing to work extra hard when I was motivated and promising myself not to allow the times I was unmotivated to continue for too long. Then I had to examine my ambivalence about recovery. That was crucial. A lot of people do not really want to talk with you about ambivalence, they just like to tell you that you are ambivalent and you shouldn't be. Well, whether I should or shouldn't have been, I was. And you know ... I had a right to be. My eating disorder did a lot for me. It was a loyal shield and a sturdy sword. I could fill a hundred pages with lists of how my eating disorder served me, and it wasn't as simple as just finding something else that was healthy to replace it.
I knew I would never find anything that would do all of the things my eating disorder did for me. And, you know, it's really okay to talk about the things your eating disorder does for you that help you. One major thing it did for me was kept all of those awful, ugly, brutal things my family did to me at bay. As long as I had my eating disorder I never had to really look at the impact of severe trauma on my life. I am not saying I was unwilling to look at it --- I'm saying I was too busy to look at it. My head was incessantly engaged in performing mathematical feats related to my caloric intake and expenditure that were more complicated and time consuming than any problem I'd ever encountered in calculus class. Keeping my pain at bay was what helped me survive. I was very much alone with my issues and they are not the sort of issues you sort through and survive alone. So, while many people are quick to point out that my eating disorder nearly killed me on several occasions, it is important to remember that it also kept me alive. Certainly that is something worth talking about.
My eating disorder was a way of communicating. It was saying, "I'm not OK" Whether through appearance or behavior I was saying, "I hate myself. I hate my life. I'm in intolerable pain. Please help me." I harbored the legitimate fear that if I looked normal and normalized my behavior people would not hear my pain, and I would be denied comfort. I look back on this fear as being odd, because no one comforted me when I had my eating disorder. although the eating disorder itself was comforting to me. I think, too, that it somehow felt good when people were checking on what I ate, because it made me feel a tiny bit cared for, and never in my life did I feel cared for or about. I worried that people would conclude that because I looked fine I was fine --- and I was pretty clear within myself that I was anything but fine. Interestingly and quite sadly, that is exactly what happened. When my symptoms began to wane, I fell through the cracks. No one heard me or my pain, and I felt very alone in it. I was going into the program everyday saying, "my life isn't manageable. I'm not okay." No one paid any attention. Furthermore, I was with people who were quite active in their eating disorders, something that I found to be very provocative. I was not yet comfortable with the new behavior I was practicing. It felt like my old beliefs and behaviors were being reinforced, because I was surrounded by people who were constantly engaging in them.
This was the one time when I desperately wished there was some sort of intermediate track for people recovering from their eating disorders. I envision an intermediate track to be where you would receive support for your pain, as well as the necessary reinforcement and encouragement for letting go of your destructive behaviors and thought patterns. I do understand why I was not heard. I was very clear about 'why' when it was happening, and I constantly pointed it out to the treatment team. I was not in 'crisis.' They were busy dealing with people who were medically unstable, and at that point in time I was no longer medically unstable. Their focus was on patient "A" who was at risk and needing to go inpatient for a tube feed as soon as they could convince her to do so. And while I was in trouble myself, my eating disorder was okay, and therefore I was seen as OK. Unfortunately the result was that I needed my eating disorder to cope, I slid backwards and lost ten pounds, at which point my pain was acknowledged. I pointed out to the treatment team that I had actually been rewarded for regressing. While I sympathized with the team's dilemma, I also asserted that I did not think that meeting the needs of the 'sickest' patient should necessarily have to have been at my expense or anyone else's for that matter.
What is the answer to not being heard once you give up your eating disorder you ask? Finding your voice. This is something I wish treatment professionals would encourage and foster. It was necessary for me to expand my vocabulary to express the wide range of emotions that were conveyed through my eating disorder. If people would not hear me or my pain unless I starved, I had to make them hear me with my voice. I had to be very persistent in using my voice, because people were not at all accustomed to hearing it. When they didn't hear me or didn't understand I had to keep going back and trying again. I had to say repeatedly, " You're not hearing me. What I said was..." Sometimes it felt like I was stamping my feet saying "No, that's not it, you're not hearing me..." When people would not let me talk about something that felt important to me, I had to say "This is my treatment and I need to talk about this." Finding and using my voice was the most difficult thing I did (and still do today). Speaking up meant I was taking care of myself. It was a way of affirming that I mattered, and that was something that I did not even believe yet.
I made a conscious decision to listen to my heart and follow its direction. At first just identifying the voice in my heart was difficult. I had to really listen and struggle to be able to differentiate between the voice in my heart and the critical voices of my low self-esteem and eating disorder. I learned that the voice of my heart is the soft, gentle one. It is the one that begs me to honor my process and take care of myself. It never tells me to do anything that would hurt me. My desire to follow my heart came before I actually cared about myself, and that made it hard for me to be assertive. This was a time when changing my vocabulary proved to be invaluable. I would often preface things with, "My heart needs me to..." or "My heart is telling me to talk about..." Using this phrasing was incredibly accurate because that is both what was happening and how I felt about it. I really was, and I really do listen to and follow my heart.
Even once I learned to love myself (an ongoing challenge) and take care of myself, I found using my voice to be a difficult task. Sometimes I just felt like I was a pain in the neck. I didn't want to bother anyone, I didn't want to annoy anyone, and I really didn't want to sound like a whiny spoiled brat. I found changing my own way of thinking about it to be key. I began to look at giving up my eating disorder as an act of courage. And it is. I tried to see myself as a warrior and not a whiny brat. For a time it helped to have others be a part of this. We could support each other in moving towards and practicing healthy behaviors, instead of competing for the title of the 'sickest anorexic' or 'sickest bulimic.' (At least it felt like that competition was there. You know, when everyone walks into a room and immediately tries to figure out who is the thinnest.) The road to health is the road of a warrior. I think it would be quite helpful to have a few warrior sisters fighting along with you. Giving up your eating disorder and taking gentle care of yourself is the triumph of warrior strength and courage.
This is the fight for your life, and your life has incalculable value. For my whole life I was the only one who ever thought my life was worth fighting for... and for a while that was what my eating disorder was about, fighting for my life. But I am here to tell you there is another way. You deserve to have peace and joy in your life. You deserve to have the life-affirming connections of healthy relationships that can and will fill your life if you allow room. These connections can and will sustain you in ways far more fulfilling than your eating disorder. You are worth fighting for. even though you probably do not believe it now, you really are. You are a warrior everyday that you struggle and strive and choose life. I believe in you!
*I found utilizing groups and nutritionists for processing food-related fears, and reserving individual therapy time for my 'other' issues achieved a good balance and worked well for me. This is not to imply that I only used groups for this purpose, however.
Copyright 1997 by Monika H. Ostroff
Monika Ostroff, Co-author, Anorexia Nervosa-A Guide to Recovery.
Email:Monika@alum.wellesley.edu
