I have had many conversations over the last few weeks about the care available for people suffering with eating disorders. There has been a lot of information about it in the media, including news articles about the waiting lists for care and the lack of support available. This was the news article publicised in the guardian this week http://www.theguardian.com/society/2015/jun/14/eating-disorders-long-waits-nhs-treatment-lives-risk (please only read it if you are prepared to see a picture of an underweight person sitting on a bed).
I have the privilege of travelling around the UK visiting Adult Inpatient Eating Disorder Units assessing them for the Royal College of Psychiatry to ensure they meet a set of national standards. What I see time and time again is a frustrating system. People get admitted to hospital and are released back in to their communities. They get 24-hour help whilst they are inpatients and then they may attend a day programme (if they are lucky). However, when they are discharged, they can sometimes rely on only one appointment per week with a therapist.
Someone said to me recently that a normal person makes around 250 eating decisions per day. I’m sure that for people with eating disorders, each of those decisions takes a lot longer and there will be a lot more of them (in fact, those decisions can steal away your whole day). When someone is an inpatient, those decisions are mostly taken away from them and they are encouraged to each enough to restore weight. The difficult stage in the recovery journey is when the person is a healthier weight and has more emotions than they used to. For some people with eating disorders a low weight can control some of the anxiety they experience at a normal weight. When their weight starts to restore, they begin to feel these emotions again and they can feel very scary indeed. This is often the point when less support is available.
I attended a multi family therapy session this week where I was supporting families who were receiving support from the NHS. I had a long chat with the other healthcare professionals about recovery and how it is maintained. The truth is that weight restoration is a battle (and I would not want to belittle anyone going through it at this current time). However, the second part of recovery is understanding your fears and anxieties and learning how to manage them. Quite often when you have weight restored, you not only have extreme fears about being a ‘normal weight’ but you also have a whole set of feelings about life that you didn’t always experience when you were underweight.
So, quite often at a normal weight, you still have the same fears about your eating choices and you also have extreme fears about life. Is it any wonder that people ‘dip their toe’ into the choppy waters of recovery and then run back to the sand where it is safe? Not only do they get more support when they are on the sand, but they get more support at this stage because they are physically unwell. The sea is unpredictable and the waves toss you about. It feels like there is no one there to save you.
I offer a different explanation for the lack of provision for inpatient beds within the UK. There needs to be more support for those who have weight restored but haven’t learned to process the other fears they are experiencing once they experience the defrosting experience of their recovery. It is overwhelming. You need to know it is ok. You need to feel ok with experiencing pain. You have to learn not to trust a lot of what your brain tells you. I think so often that people can’t recover because they don’t receive the support at the most vital stage. They aren’t told that experiencing more emotional pain is normal (although why would anyone want to believe that?!). For some, therefore, they retreat back to the sand where it is safe, even though it can be physically destructive. It is their place of safety.