Content warning: eating disorders (anorexia, bulimia, EDNOS).
Last Valentine’s Day, I sat alone in the waiting room of the eating disorder wing in UCSF’s children’s hospital—crying mid-morning on a Wednesday. It was about three weeks since my anorexia-induced heart scare. The sense of my own inescapable mortality hovered like fruit flies over browning bananas forgotten on a kitchen counter.
“Cori?” a nurse called me back down a fluorescent white corridor. I followed her into a sterile room decorated for someone at least a decade to a decade and a half younger than me—Curious George stickers on the walls. The nurse instructed for me to take off my shoes and leave them with my bag in the room while we went into the hall to measure my height for the third week in a row as if they expected it to change. She noted it onto a clipboard and motioned for me to come into another horribly lit room.
I took off my clothes (down to my bare ass) behind a curtain, as she instructed, and put on the hospital gown. Knowing the routine, I stepped backwards onto the scale and the nurse scribbled down my weight without informing me of my progress towards weight restoration. I redressed and made my way back to the room with my belongings.
“The doctor will be right with you,” the nurse said, after taking further vitals. She shut the door.
I laid on the lined table, thin paper crinkling beneath my still thinning hair—the long, lean light bulbs stinging my eyes. My skin still didn’t feel like mine. My clothes were beginning to fit differently. Under the instruction of professionals, my parents removed the scale from my apartment. All of my control was surrendered to further my life.
Curious George, that sick, happy creature, mocked me with balloons and joy and livelihood as I laid on the table, seemingly ready for dissection. Over the past few weeks, I had been struggling with the aggressive recovery meal-plan that forced me to eat essentially six meals a day (three regularly portioned meals, three Cheesecake Factory portioned meals) even though I had been starving myself for the past five months. My psychotherapist and I asked the doctors to adjust the meal-plan so I would gain approximately half a pound to a pound a week (instead of UCSF’s intended one to two pounds a week) because of the psychological implications of my body dysmorphia. The doctors did not listen, despite my requests backed by another mental healthcare professional. Over the course of my pseudo-recovery, I gained on average four pounds a week without any adjustment in my meal-plan, and I even received criticism from a doctor telling me that the rate in which my recovery was happening was “not fast enough” and that I “really needed to adhere to the meal-plan as directed.” This encouraged behaviors that led to me developing bulimia, which I had never struggled with before my weight restoration. Every night I curled up to a heating pad over a bloated belly, struggling with a compulsion to rid my body of the pain of its own nourishment. A lump in my throat. Crying into a damp pillow. Food up to the vocal cords. And there those sick stickers were, plastered on the walls with their monkeyish pleasantry despite the fact that I had been crying the night before, and the night before that, and the night before that, and even in the waiting room fifteen minutes prior. How dare they remind me of living when I had been in the process of dying!
Later, I asked my therapist what recovery looked like. She spoke of intuitive eating, body acceptance, self-love, eating without guilt, yada yada yada. I knew that.
“I’m sick, but I’m not an idiot,” I wanted to say. I didn’t.
Beyond weight restoration, I had no concept of what recovery looked like in reality, but I knew that this was not it. With the newfound bulimia (which felt like anorexia’s long-lost uglier sister), I knew that on the surface I looked healthier, but I was actually unhealthier, or maybe equally just as unhealthy. Every time I skipped a meal or purged or had a low-calorie food and passed it off as the regular calorie version I plunged into a senseless pit of guilt that overwhelmed every ounce of my being. I wanted to be better in the depths of my soul, but I did not know how, and I was tallying every mistake I made like a prisoner counting the days on the wall of his cell.
It was then that I realized that everyone around me had it completely wrong.
It was not about my weight, the numbers that corresponded to my body or medications, it was not about charts, putting labels to moods and feelings—it wasn’t about any of that at all.
In the urgency of treatment, everyone had forgotten that I was a human. Instead, anorexic had been scribed on my forehead, and I had been treated with the most prescribed, unpersonalized care that fit that brand of illness. They had sent me off with a healthier number but not a healthier mindset and pushed me off assuming I’d go floating away into the sunset like the end of Grease, when in reality, I felt like they had tied me down to a coal mining cart, pushed me down a darkened railway, and called the depths “recovery.”
With the distance between the present me and the me crying in the waiting room of the hospital, I’ve found that the failures of my so-called recovery are not on me as much as they are on the “perfect recovery” narrative. As much as I would love intuitive eating, self-love, eating without guilt, and body acceptance, I have been struggling with these issues since I was six years old—compulsively riding my bike around the block trying to burn off the one-hundred calories of the Oreo Thins or Cheez-Its in my lunchbox at school, packaged in conveniently marketed “100-Calorie-Packs.” How do you unlearn behaviors that grew with you like an identical twin?
Currently, our recovery narrative sets us up for failure. Instead of openly discussing relapses, comorbidity, concurrent treatment options, alternative treatment options, we focus on why we are not adhering to the linear, upward, positive recovery path. The narrative intoxicates us, creating imaginary sharp lines between wins and losses, and magnifying every blip in the process to leave us discouraged and ultimately more prone to give up completely.
The mental health professionals I have worked with have been trained to insist that full, long-term recovery is so possible and so accessible that my natural ups-and-downs in the process feel like personal failures. If they insist that it is so possible, then why can’t I achieve it?
Mental illnesses are chronic illnesses. Inherently, you do not recover from a chronic illness. If you told someone with diabetes or Hashimoto’s disease or epilepsy to do one phase of treatment and then recover fully, you’d be seen as a complete ignoramus. So why aren’t our mental healthcare professionals treating mental illnesses as chronic illnesses that need continual monitoring, management, and attention?
A year later, I am still struggling with eating disorders, body dysmorphia, and other mental illnesses. While I am grateful for the treatment that saved my life, I recognize its shortcomings in its perpetuation of the perfect recovery narrative that is completely incompatible with any chronic illness narrative. At a professional level, we have to make changes in treating mental illnesses by not portraying mental illness recovery, but by portraying sustainable mental health management. Management is not linear, clean, or perfect, but a process that you must go through with honesty, vulnerability, and strength, and professionals must respect patients’ humanity and dignity beyond the pathology of diagnoses. Without an empathetic, personalized, and realistic model, we continue to set ourselves up for so-called failure, when in reality, we need to be set up to forgive ourselves and better ourselves for an overall healthier future.