Recently I have been thinking about what recovery is and have been pondering the latest buzz-word in the Instagram eating disorder community: ‘all-in’. So I have decided to throw my two cents into the debate.
When it comes to physical recovery there is only one way to look at it, we have to gain weight, no matter how much we struggle to accept it. Not restoring weight is a half life and essentially living in ‘quasi-recovery’, which is not a happy place to be. It may seem blunt but truly being in recovery means consistently gaining weight or moving in that direction; recovery is extremely nuanced but weight gain is definitely the end goal. There are many approaches to recovery: a meal plan, no meal plan, Minnie Maud, or ‘all in’.
So what is ‘all-in’? Fundamentally it is very simple: you eat whatever you want, when you want and as much as you want while simultaneously stopping all eating disorder behaviours and resting. That’s right no weighing food or yourself; no counting calories; no purging and no exercise, whether it is sport or low-level movement. You honour all your hunger cues, be they mental or physical and you eat what you crave. You eat when full if you are still hungry, essentially you surrender to your needs. ‘All in’ is going headlong into recovery with no holds barred. There is no way that this approach won’t lead to weight gain. All-in can certainly restore weight quicker than most other approaches, which is undoubtedly positive both for physical and mental recovery. The plaster of an eating disorder is being ripped off quickly.
That said I don’t think that ‘all-in’ is for everybody no matter how logical it seems and how successful it might be. For many people, myself included it simply isn’t the best approach. If like me an eating disorder is a way of coping with trauma, if it is a crutch for want of a better word, then ripping off that plaster as quickly as possible may well to do more harm than good. Taking away a coping mechanism, no matter how damaging it is, when someone is deeply in the throes of PTSD is only a good idea if new coping mechanisms have been developed. This can take a lot of work in therapy; before this you can be put at risk. I know that for myself I have yet to develop other options to help me deal with things, in fact it has taken years of therapy to get to a point where I am considered well enough to do targeted trauma therapy. Up to this point my non-ED coping mechanisms have not been good. I have struggled with self-harm and suicidal ideation. For a long time I have been considered a serious suicide risk, to the extent that my medications are kept in a locked safe that only my husband knows the code for. Several of my hospitalisations have been for suicidal ideation as much as they were for anorexia.
As my ED is so linked with my PTSD recovery from both has to be approached with caution, the plaster needs to be carefully removed. My trauma is linked to long term physical, sexual and emotional abuse and facing that in therapy is hideous. It is often thought that a person needs to be weight restored to be able to cope with trauma therapy and I strongly disagree with this. I tried this in each of my hospital admissions when I was getting little if any help with my trauma and guess what? I relapsed every time as I couldn’t deal with the trauma of what I had experienced. It became obvious that another approach was needed. My psychiatrist, psychologist and dietician got together (I am so lucky to have such good support) and decided that the only way was for me to do trauma therapy and ED recovery at the same time. I need to deal with the anorexia to have the energy and clear thinking to do trauma therapy and do trauma therapy to be able to deal with my past, develop new coping mechanisms and let go of my eating disorder. At this point ‘all-in’ just isn’t for me. That doesn’t mean that I can rest on my laurels, not in the slightest, I still have to eat more, gain weight and recover physically.
So, what do I think recovery is? In my opinion recovery is consciously moving forward, I see it as being in what I call ‘active recovery’. If we are ‘active’ then we are gaining weight at whatever rate and working on behaviours. It is ok not to be able to rip the plaster off quickly, as long as it is coming off. To me being ‘all-in’ means being in and being fully committed to active recovery, it means giving my all, accepting weight gain and getting that anorexic plaster out of my life. It is not accepting living in quasi-recovery, it is not thinking that weight gain can be avoided or that I have gained enough to stop when I am clearly still ill.
With all that being said the one real benefit of fully committing to what is referred to as ‘all-in’ is that it shows and gets people used to the sheer amount of food that is needed to be free of anorexia. And I think this is where a lot of people stumble, as it is likely to be much more food than the people around us eat, but we need so much more. Our bodies are so much busier than most peoples’. We don’t just need calories to sustain ourselves physically and mentally and to provide for all the energy we burn in our daily life. Our bodies have been seriously damaged, our organs are struggling and this takes a huge toll on our health. It needs a lot of energy to repair. We have to eat enough to fuel this effort even if it takes twice or three times as much as what other people eat; this is not time for comparisons, it the time to heal and focus on what we need. Clearly ‘all-in’ gets you there faster and we do need to get there, we all need this amount of energy to heal, no excuses. ‘All-in’ also gets people to rest and we all desperately need this; none of us can cheat the system, the maths is the same for all of us and being blunt, weight gain means eating lots and resting. We can’t pretend it doesn’t.
So where am I? Well in previous attempts at recovery I have never got beyond quasi recovery, I wasn’t at my lowest weight but I wasn’t gaining and still used behaviours. I started EMDR trauma therapy a few months ago and am finally starting to see real, tangible progress. I find myself thinking about things in different ways, I am starting to question what I thought were truths and I am starting to see the things I experienced from a new angle. I still have a very long way to go but I am finally beginning to heal. What is different this time is that I truly have had enough of anorexia; quasi recovery just isn’t enough this time, I refuse to not be physically recovered. That said I am not quite ready to go ‘all-in’, much as I can see the benefits of it and damn, I would like to get weight gain out of the way. I still don’t have good coping strategies and until I do things need to be done carefully. What I am doing is accepting nothing less than ‘active’ recovery, I refuse to kid myself that I am truly recovering if I am not gaining weight, even if it a slow process.
The biggest surprise for me is that since I got stuck into trauma therapy I have slowly started to eat more. There was no sudden turning point, I didn’t wake up one morning and decide to ‘just eat’. It just kind of happened and it has been slow but sure: a little bit more here, a bit more there and I have been sticking with it if I get in a rut. I really don’t know how it has happened; I didn’t consciously make a decision to recover but I am choosing to see it through. I stopped weighing myself when I started trauma therapy, but I know that when my body leaves me weak and tired that I need to eat more. And I do, for the fist time I am listening and responding to my hunger as much as I can. I am giving it my all and I am starting to see the benefits; who knew that eating more would give me more energy? I am not analysing why or how this change has come about, I am riding the wave and not giving in.
I am not ashamed that I can’t commit to the ‘all-in’ movement, maybe I will one day. I will not feel bad when I really am trying as hard as I can. I don’t think that recovery is black or white; everyone needs to do it in the way at is best for them. This isn’t a get out of jail free card, recovery does mean being active in the process, nobody else can do it for us and weight must be gained.
Recovery is hideous, hard, messy and gruelling but it is the road to freedom and we have to do it in the way that works for us. It is more than ok to rip the plaster that is an eating disorder off slowly, as long as it is being removed once and for all.