So then, the front of the brain is trying to interpret that. “Wait a minute; she didn’t like it? It was yucky? She’s got no flavor? So whoa, whoa! I don’t know if I should eat another bite, just hold back there.” So, the brain is trying to now figure out and make sense of those lack of signals. So that cortex starts going, “Is it good or bad? Maybe this is bad, maybe this is just bad toast, maybe this is bad jam. Maybe I shouldn’t just eat it. So okay, I’ll just decide I won’t eat it.”
And so now, my dorsal lateral prefrontal cortex has no idea. “Well, then what am I supposed to eat? Oooh, I don’t know what I’d do, what I’d do?” And the clients tell me over and over: “I don’t know what to do about the next bite, Dr Hill, I don’t know if I should eat it, I’m literally eating blind because I do not know what works and what doesn’t work.”
And then sitting right back in that parietal area, where they see a sense of their own sense of self, we see disturbance that is off the chart. They see themselves, as that food translates into their brain, they see themselves growing and magnifying. And the delusional impact is acute.
So, with anorexia there is increased disturbance. The moment we start refeeding to help that person who’s starving, we used to say, “Just eat and you’ll start to feel better.” I don’t say that anymore. I now say, “You’re going to eat, and it’s going to be painful. When you eat, it’s not going to feel good or think good. Because as we try to help refeed you, you’re going to have increased disturbed thoughts, while your weight is restoring. And it’s going to be miserable. You’re going to have increased disturbed thoughts, even when you restore your weight, and you may have that for a good period of time, and for some, that volume of noise never comes down, and in other cases the volume comes down.”
So the person with anorexia thinks and feels worse when they’re at a normal weight. They hit the normal weight, and all your friends are coming around, they’re going, “Oh, you look so good, you look well!” And they are literally living in the noise and the disturbance and the pain of a normal healthy-sized body. So, it makes sense why relapse has been so high. Because by not eating, I can deaden that pain, and get back to work.
If you start re-framing food, for you, food is socializing, joy, pleasure. But for a person with anorexia, it’s like the insulin to the diabetes: it’s medicine. Just, “I need to take my medicine, and I’ve got some side-effects from it. I have to eat my food.” So we have been testing and working in collaboration, and exploring new research in the sense of: can we bring the volume down of that noise? So maybe we need to pre-plan the food, pre-dose it, and prescribe it, so that they know exactly what they’re going to eat into.
So when you’re going somewhere with a friend who has anorexia you say, just like with a person with diabetes, “Do you have your insulin? Do you have your food? Do you have a plan? Do you have your food?” And so if they know what they’re taking, and they know the amount, and they know and potentially practiced eating some of that food over and over, the clients report that the noise comes down. It may not go away, but then I can hear and function and interact and get through it.
“So I am realizing that using the same meal plan is not part of the disease”, one of the clients said. “It’s actually part of the cure.”
One father got it. He got it beautifully. He said, “Okay, Dr Hill, spontaneity is out, planning is in.” I said, “Exactly.” And so they planned, because there was going to be a big holiday gathering and they were going to go to a restaurant together. And the client worked with the eating disorder dietitian, she went, she knew exactly what she was going to order, the amount she was going to order, but she also decided, just in case, she would take her lunchbox with her backup meal-plan, just like you take your insulin, when you need to take it along as well. Mom, dad — everybody knew — aunts, uncles. She was so nervous, she didn’t want people focusing and watching her, she was just trying to be like everybody else and be at this gathering at the restaurant.
So the waitress is going around, and she said, “So what would you like?” And the father leaned back to let his daughter order, and she had it all down, and she said, “I’d like this and this.”