As usually happens, when I spill my brain out onto Twitter I end up having some minor (or, let’s face it, major) discussions and disagreements with other Twitterites. It’s both a wonderful and a stressful experience, in part because one of the hazards of the medium is its rapid-fire and protracted style. Inevitably, discussions lose their nuance and some of what I am advocating for gets lost in the ether.
The latest discussion centered around recovery and how it is portrayed in the literature. I’ve been working on a meta-analysis of recovery studies, and commented that I was tired of the way that researchers tend to write about recovery as “becoming whole” or finding oneself. Because I am a critical researcher and a generally squeaky wheel, and based on some research I’ve done, I question whether this framing is helpful for all of those who have recovered/are in recovery/want to recover.
What I take issue with is how seeing recovery this way makes it seem as though people with eating disorders are somehow “fake” or “inauthentic,” or that they never recognize the seriousness of their disorders and/or want to get better. In saying this, I also recognize that there are times at which people with eating disorders may deny their behaviours, may not wish to seek treatment, or may even glorify eating disorders – heck, people in general may do these things as well.
However, what might get missed in this discussion is that there are also people who recognize that life with an eating disorder is incredibly unpleasant, want to get help, and can’t. There are people who are shut out of (some) recovery communities because they want to talk about the serious crappiness that can accompany life in general. There are people who were never diagnosed with eating disorders in the first place (because of marginalization, etc.) and so live in a funny limbo in between sick and well, unsure where they belong.
Maybe this discussion comes off a bit abstract if you aren’t familiar with the literature that exists on eating disorder recovery. As an example, I’ll discuss an article by Jenkins & Ogden (2012) that positions recovery as becoming whole; I think it’s important to preface this by noting that I am not saying that this study, or all recovery literature, is bogus, or that there’s no point in looking at recovery as “re”covering the self, for some. I just think we need to be having discussions that make recovery out to be a bit more complex.
Jenkins & Ogden interviewed 15 adult women who had been diagnosed with and treated for anorexia nervosa (AN). They used self-report of recovery, instead of measuring this with an instrument – as I’m increasingly learning in my stats classes, this might be just as well (see also this post about the issues with a common diagnostic tool one might use to determine if someone has an eating disorder or not, the EDE-Q). Unfortunately, we know nothing about the demographics of the women besides:
- Ages (range 19-49)
- Age of onset of the disorder (range 13-26)
- Where they received treatment (mostly in or outpatient eating disorder units, with some receiving private counselling)
- Whether they’d reached their target weight (3 had not) and
- Whether they defined themselves as recovered, in recovery, recovering or semi-recovered
I would really like to know more about things like race and ethnicity, socioeconomic status, body size, sexuality, abilities and more possible axes of marginalization. I’ll earmark this as one of my main areas of discontent in terms of the literature that exists around eating disorder recovery – discussions of privilege and how that impacts recoverability are pretty much nonexistant. Recovery is painted with a neoliberal, meritocratic brush; as though the construct were equally accessible to all if they only work hard enough.
An important note: I do not think that the researchers are purposefully positioning recovery this way, and I do not mean to imply that they don’t care about people in all of their complexity – I’m sure they care deeply. I only mean to point this out in terms of how to be more mindful of social justice in conversations about recovery.
What did they find?
Back to the study. The researchers interviewed the women and conducted interpretive phenomenological analysis (IPA) on the data. This method is intended to be “experience close,” or to unearth the meanings that participants have for their experiences.
They group the process of recovery into three areas:
- Being anorexic
- Process of change
- Being recovered
Within each of these, they found a number of themes (theme names verbatim from article).
1. Being anorexic was tied to:
- Anorexic behaviour: restriction, etc.
- Anorexic cognitions: thoughts, including denial, splitting between rational and irrational
- Anorexic voice: something held inside that threatened to overpower and/or drove behaviour
- Anorexia as a means of communication: coping through AN behaviours
2. Process of change was related to:
- Difficult journey: challenges in the process, need for strong supportive care
- Limitations of therapy: GP lacking awareness, being treated as a disease not a person
- Using therapy/relationships: gradual shifts to buying into therapy and working through challenges in therapy
- Managing emotions: connecting with emotions that emerged in process of recovery
- Acknowledging consequences of AN: seeing how AN impacted life goals
- Controlling AN voice: learning to ignore or shut down thoughts related to AN
3. Being recovered meant:
- Ambivalence about recovery: generally linked to weight gain, control, and achievement
- Benefits of recovery: or moving from ambivalence to seeing how recovery was a better way of achieving life goals
- Managing anorexic identity: or finding new things to define themselves
- Description of full recovery: moving beyond obsession with food/weight to comfort with self
In general, the authors describe the process as women passing through a series of dichotomies on the way to a happier and healthier life. The authors firmly externalize the eating disorders, in line with what they heard from participants. In other words, the women’s “AN voice” is seen as distinct from and separable from the person’s voice or desires.
Now, externalization can be an incredibly helpful tool for many. Arguably especially in early recovery and/or for younger people, externalization can help to overcome some of the issues I touched on earlier that can be very real: like denial of the illness, not wanting help, etc. It can also be a helpful tool for parents and friends, who can identify “Ed” as the enemy in this scenario. But I find there’s a fine line with externalization.
Paula Saukko (2008) has written about this tension, exploring how sometimes externalization can be complicated by how the “AN voice” and the “authentic voice” are not always very distinct or separable. Some parts of the eating disorder are adaptive in other parts of life – a cautionary note is that, again, I am not saying that eating disorders are good or helpful – things like perfectionism and control are actually highly valued in society, and might be part of a person’s personality regardless of their eating disorder.
When you really start to think about it, it is also challenging to fully distinguish the ED voice in a world that, essentially, speaks fluent “ED voice.” I’m not only talking about food, here, but also productivity and success.
Another potentially problematic way about the way recovery is described in this article is that it re-entrenches a split between mind and body. What do I mean? Well, the authors write:
“Full recovery occurs when the AN voice becomes muted via relationships boosting a sense of self, which includes a shift in power from body/AN side to mind/rational side so that the mind/rational side can regain control and use language and relationships to express psychological distress rather than using bodily forms of communication” (e30)
The problem, here, is that you might notice that the body is associated with the eating disorder, and the mind with control. Minded, rational communication is valued over bodily communication. Now, that’s fine and all – being rational can be helpful and useful. However, there are other ways of communicating bodily than having an eating disorder (of course). People are not going to logic their way out of an eating disorder.
Elsewhere, the authors write about the need to bridge mind and body and bring them together in recovery. However, there’s a real sense in quotes like these that recovery=rational mind and eating disorder=irrational body in a way that colludes with some dominant ideas circulating in society: that logic will always win, that bodies can (and need to be) controlled, and that all people pass through a series of stages in a linear way toward a happy, healthy, and productive life.
Recovery: No One Size Fits All
Caveat number 300: it is not, and has never been, my intention to say that recovery is not possible, or that seeing recovery as a panacea or something happy and sunshiney is a bad thing. I think it’s awesome if people see recovery that way, and I’m very happy that they’re living their best lives. It would also be incredibly hypocritical for me to say that recovery could never be spectacular – I myself live a recovered life that is inordinately better than the (not much of a) life I lived with an eating disorder. However, I do think it’s important to note (as I also did in this post about body privilege) that my life would always have been easier because of my privileges. I am more easily able to navigate this world in the body that I have.
What this boils down to, then, is how we need to make space for those who live in complex relationships with their bodies, food, and their recoveries. Space for people who are fully aware of the distressing nature of their eating disorder, but are unable to access the kinds of support that might help them to work through this. Space for people who will never embody the norm, no matter how rational and logical they are. Space, I would argue, for people who live recovery “imperfectly.”
We are not doing anyone any favours by telling them that recovery is perfect – we’re setting many people up for disappointment. This is not because recovery is not possible, but because life is imperfect. There’s no one checklist to prove recovery, because recovery will necessarily be impacted by who you are and where you exist in society.
All of this, of course, is complicated by a broader discussion to be had about what an “authentic” or “whole” self is, anyway. I could probably wax philosophical about that for a while, but I’ll spare you for now. At the end of the day, it boils down to this: people will have different experiences of recovery. One is not more real or fake than another, whether that experience includes sunshine and rainbows, turmoil, or something in between.
Jenkins, J., & Ogden, J. (2012). Becoming ‘whole’ again: a qualitative study of women’s views of recovering from anorexia nervosa. European Eating Disorders Review, 20 (1) PMID: 21394835