Dieticians never fail to amaze me, never a dull moment and all that. On paper they should be a great help in eating disorder recovery. Their job is to help people eat a balanced diet, adapt to a special diet and manage weight. Great, you say? Well not always; I certainly haven’t had the best experiences with them and I know I am not alone.
My first experience with a dietician took place when I was pretty much at my sickest, I was entirely entrenched in anorexia and I honestly don’t think that anyone could have got through to me at that point in time. I didn’t want to see her; I simply didn’t think I needed to. I was terribly dissociated from my situation but I turned up to the appointment anyway. It didn’t go well. I wasn’t weighed which was a relief as I really didn’t want that. We barely discussed food at all except for her telling me that I shouldn’t be vegetarian, something I had been for many years before I fell ill. She focussed on my feelings to the extent that I felt I was seeing a psychologist, I needed to simply think differently so that the eating would take care of itself. What? The worst part of the experience though was her telling me that I would see a ‘real’ emaciated anorexic when the next patient arrived. She couldn’t have invalidated me more; I already didn’t feel like I really had anorexia or that I was sick enough. This happened before I had been treated inpatient, something I had decided was necessary to ‘really’ have anorexia. I left the room feeling a mixture of glee and horror and yes, the next patient did make me feel like a huge, round elephant.
My next encounter with a dietician when I was inpatient. Backing up a bit, I first want to give some background to the treatment that was offered. When it came to food we chose our menu for the next day every morning; nobody paid any attention to what we ordered so it was easy to just not order things. Once the meal was in front of us we could eat as much or as little as we wanted and nobody paid any heed to eating disorder behaviours being used, not that we needed any seeing as we could throw anything we hadn’t chosen to eat in the bin. I, for one, managed to basically not eat carbohydrates during a total of seven months there over four admissions. I didn’t eat rice, noodles or pasta and it was all too easy to do. There was a dietician on the team who I didn’t even see until my third admission and she wasn’t helpful. The advice for facing fear foods was essentially to make ‘friends’ with them in stages. Step one was simply to order them so they were on our plate, then to progress to maybe eating a tiny mouthful, eating the portion was not deemed important. I ordered pasta maybe twice and then just didn’t bother; with nobody checking what we patients were doing there was no incentive to fight the voices in our heads and bother trying.
Outside of hospital I have worked with two more dieticians and the experiences have been bizarre. The first, as it turns out was not a medical doctor, something I didn’t know until I had given up on making any progress with her. During my first appointment I filled in a sheet detailing what I ate from day to day. Even I knew that it wasn’t enough in terms of calories and variety, in all honesty I was quite embarrassed by it and expected to leave the appointment with a meal plan that terrified me. This really wasn’t the case; frighteningly she was happy with what I was eating even though the number of foods I was prepared to consume could be counted on my fingers and that was on a good day. I was given a meal plan based around the things I did eat and a pitifully low calorie target; I wasn’t going to gain weight on 1200 calories a day. It was like waving a red flag to a an anorexic voice. I was filled with glee, a professional didn’t want me to push myself, game on! I didn’t expect to feel like this, I thought I would be filled with fear and panic: how could I possibly eat that much; how could I possibly eat those things? My eating disorder breathed a sigh of relief.
Unsurprisingly I made no progress whatsoever and spent the following year as stuck in my eating disorder as ever. In many ways things got worse. By this point I had gained some weight and was stuck in a stagnant quasi-recovery state; I remained very underweight and now ate even fewer things than I had the year before. It would be safe to say that the situation had become ridiculous and I knew it.
Fast forward to today and I am really doing the recovery thing: I am eating more and moving less but more importantly this time I want to get better. I am doing it for me, for a better life. I had no desire to work with a dietician again but my psychiatrist was pretty insistent that I give it a go. She recommended one who specialises in eating disorders and who has a stellar reputation and I agreed. I went in with an open mind, otherwise there would have been no point to be honest. Yet again there was no weighing and no meal plan and I was starting to wonder what dieticians were all about, by this point I was getting desperate. I really needed help both to eat more and more variety; I wish I could say that I got what I needed, but I didn’t. My most recent appointment started with her asking me how my mood was and by her telling me that anorexia recovery is not about weight gain. Woah! I may have spent years resisting weight gain but I damn well know that is absolutely has to happen. I may be doing better than ever but my brain remains very disordered and that anorexic voice still piped up telling me that I don’t need to gain weight. Once again I felt like I had been given a get out of jail free card. Apparently all I have to do is see the positive side of life and stop seeing myself as a depressive and I will get better; she might as well have told me that fairies exist and are the solution toall mental health problems. I felt let down and lost.
I can’t help but wonder if I am missing the point of dieticians. What should people with eating disorders expect to get from them?