What quasi-recovery feels like

TW: explicit discussion of disordered thoughts

There are many competing narratives when it comes to understanding what it means to ‘recover’ from an eating disorder. There’s a term that gets thrown around in online eating disorder recovery spaces, that is; ‘quasi recovery’. Usually this means something like making an attempt to recover but still participating in some of the behaviours associated with your eating disorder – so basically anyone who isn’t ‘fully recovered’, if we’re honest. The idea is usually that in order to ‘fully recover’ one should be constantly striving to rid oneself of any behaviours and disordered ways of thinking entirely. There are differing views as to what that might look like and, also, whether it’s even possible.

Can you ‘fully’ recover from an eating disorder? It’s a complicated question. I wanted to write this because I’ve observed a lot of different narratives about this and I’m interested in why that is and who is invested in which, what motivates them?

What does it mean to live with a brain that still has all the thoughts but not to act on them? Is that really what recovery is? Sometimes it feels like it hurts more. That isn’t true but you want it to be true. Then you’d have an answer to it all which is, of course, to relapse. To go backwards. To retreat. Go back, deep inside, where it’s safe.

Recovery feels like such a healing word – it makes me think of little wooden huts inside a great, deep pine forest and there are sparkling springs and everything feels fresh and clear and smells amazing. It makes me think of being under blankets, sitting in a window seat with a really nice mug of a hot drink, writing in ink pen something deep and meaningful. It makes me think of a respite, a pause whilst you figure things out. Everyone’s waiting for you but you take as long as you need. Someone makes all your meals for you and they all taste perfect. You don’t have to worry about it, there’s enough vegetables and fruit and protein and everything. And you just do yoga all day and you’re really good at it. You walk around the forest and swim in the water. Nobody asks you to weigh yourself. Nobody asks anything of you.

Maybe that’s what rich people do. I don’t know. It’s definitely nothing like anything I’ve actually done in recovery. I still live in Birmingham, I still need to work or claim benefits or both. I don’t have a window seat with a nice view. I have to cook for myself most of the time or order in or just don’t eat for fucks sake. I’m tired. I feel like I suck at yoga now because I couldn’t do it for a while and I made it into this fucked up competitive exercise thing which is so not what you’re meant to do because I’m an idiot. People are always going to ask things of me because capitalism.

My experience right now is constantly having neuroses about the food I eat, often fucking it up by not eating for a while then eating loads and making myself feel sick and giving myself heartburn all the time. Worrying about getting five fruit and vegetables a day and counting them obsessively. Deleting and then re-downloading my calorie tracking app every other fucking week. Still can’t deal with putting spread on anything and want to scream when other people do it for me.

Wanting to train really hard, making myself exercise plans, feeling better when I tire myself out. Wondering how the fuck I’m meant to fit in three strength workouts as well as swimming, climbing and martial arts. The answer is you’re not. It just feels like all this eating…you’ve got to do something about it.

Being entirely terrified of gaining any more weight.

I want it to be over. So fucking bad.

I think there’s a lot to unpack about the term ‘recovery’ in and of itself. It’s used in a lot of different contexts including recovery from addiction, eating disorders and other types of mental illness. It presents a certain type of narrative – that of being unwell and of actively seeking to address this. It is presented as some sort of ‘journey’ that one has to pursue, something to be actively worked on and committed to. From an outsider perspective it seems fairly straight-forward – you have a mental illness and you try to recover from it in a similar way that one might go about trying to recover from a bout of flu. There are things that help alleviate the symptoms, you have to do a lot of resting, if you’re lucky you can take some time off work and eventually you won’t have the symptoms any more and you can go on with your life.

I think there are several tendencies, schools of thought and approaches to eating disorder recovery. One I’ve noted often in online recovery orientated spaces seems to relate more to the addiction analogy; the same kind of thing that one has to pursue when signing up to Alcoholics Anonymous or a ‘12 step program’. This appears, at times, as an all or nothing approach, usually promoting abstinence only rather than harm reduction. It maps on to eating disorders in some ways, or tries to.

Firstly, the ‘12 step program’ approach is not necessarily scientific; it’s religious. It will often explicitly ask people to put their faith and in a ‘higher power’ of some description in order to be able to believe that, in some way, they are at it’s mercy in their recovery. Or else, the idea is that you should accept passively that you are ‘ill’ but also accept actively that this is all down to you personally – a fundamental contradiction of concept. Does this Higher Power take away agency or award it? Certainly, many of the ‘steps’ involve taking accountability for one’s own actions but, not only this, taking responsibility for getting ill in the first place. For addiction this certainly appears to be self-evident – didn’t you chose to drink or take drugs? If we treat eating disorders as a type of addiction, which seems to be the proposal to some degree, then did you not also chose to not eat?

I find this framing comes from a culturally specific context in the USA. Religion is, in many ways, more powerful as a political force in the US which then impacts on the type of healthcare provision provided, lobbies and what is seen as acceptable in treatment. There’s probably a whole lot more to unpack in this vein but suffice to say that this provides a little context for how narratives of recovery seem to play out in self-help books and online recovery communities at times.

I’ve found a lot of these concepts are parroted or mirrored in ‘recovery content’ on social media – the core tenants being; full recovery is possible, this means no longer enacting any of the behaviours or thoughts associated with your eating disorder, this is the ultimate goal and one that is obtainable. This is, at it’s core, an abstinence approach. This, I think, is where terms like ‘quasi recovery’ make sense – as in, you can acknowledge that someone has put work into recovery but they have not fully abstained and therefore their recovery is only partial. This is usually framed in a fairly compassionate way but many posts are also quite firm: you need to challenge your thoughts, this is the only way to really be recovered and you cannot hope to achieve happiness if you’re not able to do this.

What’s quite attractive about this approach is that it promises an end to your suffering. Like – it really will end, you really will no longer suffer from these thoughts and behaviours, you will be free. Even people like Tabitha Farrar, who is not particularly openly beholden to the addiction recovery style approach, do make claims like this. As in, that you can really be free of the behaviours and thoughts of your eating disorder. I don’t claim to know the answer to this but what I do think is that this promise lays out a particular way of viewing eating disorders and mental illness and recovery from them as some sort of personal development journey. Within this framing there must also be the promise of freedom and also the belief in the fundamental possibility of freedom.

I don’t think everyone who claims that full recovery is possible necessarily is beholden to the abstinence ideology of addiction treatment but I do believe there is overlap. I think the other tendency within the full recovery advocates is one of self-help, CBT (cognitive behavioural therapy) and ‘brain re-wiring’. As in, the idea that it is possible to unlearn behaviours entirely and this is why you’ll no longer have the behaviours or thoughts of your disorder eventually.

This is not without evidence, incidentally, as CBT is very much ‘evidence based’ which is why the NHS love to wheel it out so often. It’s very outcome focussed and has been shown to improve symptoms particularly in patients with OCD and similar behaviour based issues. This is because it essentially attempts to systematically re-train your brain to have a different response to the same stimuli. The thing that was viewed as a threat may stop being viewed as a threat with the right practice and perseverance. If this works then it stands to reason that you could theoretically eventually train yourself out of all eating disorder behaviours and thought patterns.

When you are suffering so acutely, when your life is utterly miserable and filled with these disorders there is nothing you want more desperately than the promise that your suffering will end. Yet there are those who claim that one can never truly recover from an eating disorder, that you will always be in ‘remission’ from it and that it could return at any point in your life. The phrasing of ‘remission’ posits the disorder like a type of cancer that must receive aggressive treatment constantly and be checked up on regularly in order to prevent relapse. And so, this might be seen as more analogous to a ‘harm reduction’ approach if we are to continue with the addiction analogy. The idea being that there will always be thoughts, behaviours but that they can be reduced and the person can be taken out of harms way via treatment and constant vigilance around relapsing into the full disorder (usually correlated with severe weight loss).

This is quite a bleak view, primarily seeming to be taken by professionals who may have more experience with the severe end of the eating disorder treatment spectrum. Certainly it seems to be true that many patients with severe symptoms in need of things like re-feeding seem to revisit hospitals and in-patient treatment visits multiple times. There is also an explicit acknowledgement of relapse; one that almost anticipates it, rather than merely accepts it as a possibility.

So, of the two approaches there seem to be flaws – namely, in an all or nothing approach there is this singular drive to perfectionism in recovery that mimics that of the eating disorder. Yet, in a ‘harm reduction’ approach there is a type of fatalism which almost pre-determines relapse as this even encroaching force in your life. Of course, there is a lot more subtlety than this in reality which it is difficult to portray or even understand when you’re muddling through this yourself.

When I was first trying to recover I felt so confused by the seemingly contradictory advice I was being given. I read Tabitha Farrar’s recovery books, followed a bunch of recovery accounts that were doing this ‘all in’ approach – basically, eat as much as possible, anything you want, all the time and stop exercising completely. The idea being you just constantly challenge your brain, take opposite actions and throw yourself straight in the deep end. Meanwhile, professionals and other books had a more conservative approach which included making meal plans and gradually scaling up the number of calories I was eating until I got to more normal levels, introducing new foods on a weekly basis and only doing simply exercise like yoga. These two approaches more or less map onto the ideas about recovery I described above – full recovery = all in; remission = gradual approach. Both make sense when you follow their internal logics. At this point I don’t think I understood that the reason they were so different was because they had competing views of not only what was possible in recovery but also what recovery actually was.

So, is recovery striving to go ‘all in’, rid yourself of every thought, behaviour and logic of your eating disorder and anything less is merely ‘quasi recovery’ or, at the very least, a partial recovery? Or is it some sort of game you play, staving things off for longer and longer until their inevitable return but maybe, just maybe not quite so bad this time because you’re prepared for it? Certainly both scenarios are far better than having a full blown eating disorder and in both many of the key symptoms of starvation will begin to alleviate, your physical health should improve significantly and you’re overall likely to be doing better mentally.

My experience is that recovery isn’t linear, in any case, and I think that means it’s possible that both of these ideas could be true and it’s just the framing that’s different. Was my little relapse over Christmas because relapse is inevitable and I had just been in remission before? Have I now returned to remission? Or is it because I didn’t commit fully enough, because I wasn’t ‘all in’ enough? Did I just have a slip up but I’m still on my way?

In a way – what does it matter? Perhaps the reality is what works for one person may not work for another. I really hope people who say they are fully recovered are right. I hope people who say they’re in remission feel satisfied with the work they put in. I’m just under five months in to my journey so, the truth is, I don’t know how things will end up for me. All I can do is keep trying.

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