Surfacing After Silence

Life. After.

Relapse As A Choice


There’s been a bit of a debate on Facebook recently, which in and of itself is not a surprise.  This time the topic of interest is the Maudsley Approach to treating eating disorders. There are some sites and forums run by parents as a support network.  I’m not a big fan of the Maudsley Approach, and I never have been.  

I am concerned that a great many parents using this approach instill in their children the believe that full recovery is not possible.  They say recovery is possible, but that you will always have to guard against relapse.  Supporters of this approach base a lot of their treatment modalities on the belief that an eating disorder is an illness of the brain.  

I don’t disagree with that.  But I don’t think an eating disorder is ever only caused by one thing.  I have a predisposition to Bipolar Disorder.  So does my brother.  It’s in our family.  But because of situations and environments that happened to me, I developed Bipolar Disorder; he did not.  You can say it’s a nature-nurture debate type of thing, except I don’t believe it’s ever one or the other.  Life doesn’t get separated into little boxes so neatly.  We can try, but life rarely works out that way.

The general belief among medical professionals is that an eating disorder in one individual usually has at least seven causes.  That’s why we can’t place all the blame on the media for inundating us with images of skeletal models.  Nor can we blame faulty parenting alone.  I know in my case, it was a result of early childhood trauma, a perfectionistic personality, an overachieving personality, involvement in athletics, the Bipolar Disorder, fear of change, fear of abandonment, and a desperate need to control the situation around me since I control and safety were taken away from me as a child.  I have no idea if I have a genetic predisposition to an eating disorder.  No one else in my family has ever had one.  And no one has tested me for it.  

But here’s what I do know: recovery was a choice I made.  A series of choices, really.  And I made the choice that I didn’t want to “guard against future relapses.”  Why do I want to live a life constantly looking over my shoulder, waiting for the next blow?  Life is going to sucker punch me in the gut no matter what, so I may as well be in the moment.  

And the concept of being on guard against a relapse presupposes the notion that relapse is an option.  If I’m always watching out for the triggers, then somewhere in my mind, there is the seed of knowledge that “if things get really bad, I can always go back the eating disorder.”  I will not allow that seed to be anywhere inside of me, ready to dig it roots into me at a moment’s hesitation.  Relapse: Not an option.  The freedom this gives me to live my daily life is amazing.  

My previous therapist told me in one of our last sessions to remember that relapse is a choice.  And, of course, I immediately raised my hackles at this.  I mean, aren’t we taught that the illness is not a choice?  But he is right.  The onset of the eating disorder is not a choice.  Recovery is very much a choice.  And once you have entered recovery, so is relapse.  

If you think I’m pointing fingers or trying to start a controversy, this applies to me as well.  The last time I relapsed, there were people offering me help, there were options available.  I knew how to pull myself out of it.  I had done it before.  All I had to do was open my mouth, ask for and then accept help.  But instead, I fed myself the lines of “I won’t let it get out of hand,” and “I’ll stop when I reach a certain point,” and “I know what I’m doing.”  And I kept doing the same old shit.  

The last time I went IP, my therapist saw it coming weeks before it happened.  And told me I didn’t need to go.  That if I did what he said, we could avoid that, that I could stop relying on going IP as an escape.  Part of me wanted to trust him.  Almost all of me wanted that escape.  And I knew exactly how to go about getting it.  And I was conscious of every single wrong move I made that got me there.  

Two months later, I would be conscious of every single move that got me back out.  And yes, in the beginning I did guard against triggers and relapse.  But I also made up my mind that that was an exhausting way to live, and it wasn’t a full life.  And I’d worked too hard to live anything but a full life.

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August 6, 2009 - Posted by | Eating Disorders | , , , , , , , , , , , , , , ,

4 Comments »

  1. first time at your blog. 🙂 thanks for sharing, i will be reading.

    Comment by janie | August 6, 2009 | Reply

  2. Wonderful-what *power* we get when we can choose to relapse or not to relapse. The personal responsibility and the accountability then lies in our own hands, rather than an unknown force known as “Eating Disorder”. Great blog as always!

    Comment by Melissa | August 6, 2009 | Reply

  3. “I mean, aren’t we taught that the illness is not a choice? But he is right. The onset of the eating disorder is not a choice. Recovery is very much a choice. And once you have entered recovery, so is relapse.”
    I’m glad you drew this distinction between what is and what isn’t a choice.

    And I knew that most eating disorders had multiple causes but I didn’t know people thought it was at least 7. interesting.

    Comment by Andi | August 7, 2009 | Reply

  4. “If I’m always watching out for the triggers, then somewhere in my mind, there is the seed of knowledge that “if things get really bad, I can always go back the eating disorder.” I will not allow that seed to be anywhere inside of me, ready to dig it roots into me at a moment’s hesitation.”

    Very well said (as always). I think a lot of therapists who tell patients they always need to be on guard don’t realize they are giving this message. And it’s a dangerous one.

    Comment by Millie | August 7, 2009 | Reply


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