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.”
The waitress said, “Oh I’m sorry, honey, we’re all out of that.” She froze. Wasn’t sure what to do, she hadn’t planned, and the father looked up and said, “You know, would you give us a minute, please?”
“Oh, okay!” So the waitress went away.
And he said, “All right, you can’t eat that, this isn’t here, so, do you have your lunch?”
“Yeah, Dad, but I don’t want to make a big scene.”
“It’s all right, just get out your lunch.” And he called the waitress over and goes, “You know, my daughter has a reaction to some of the foods on this menu. She’s just brought some things she’s going to eat. We’re all going to go continue to order.” The whole family ordered, they all had fun, they all interacted, and her noise could stay low enough as she ate her meal-plan in order to enjoy the interaction as much as she could.
So, when we look at the prognosis, what’s going to happen as the future is revealed in the sense of science, and what direction we’re going with anorexia and eating disorders? And with anorexia, some may be able to stabilize, and hold onto that. And we’re seeing that especially when it’s adolescents, and that brain wires forward, and the longer they hold to that meal-plan and get it stabilized, the noise can actually wire out, calm goes, and as long as they stay within those safe boundaries, a person can move on in recovery.
So, there are some with anorexia that will recover, and some that will learn to manage. And there is a sub-part that will remain acutely ill. This is a visual replication of what I think of with anorexia. The title of it is, “Three kinds of lines, in a continuance.” We got your carbs, your proteins, your fats, in very specific dose levels, over and over and over and over. Or is this art? An Italian renaissance piece with multiple kinds of lines, clear image of what the image is.
So is a meal only a meal unless it is drawn out, filled with variety, and has all kinds of fresh and different types of foods? Or can a meal for some be something to get you through to get on to enjoy life?
Now when I was getting ready to prepare for this, something that I experienced was a great deal of anxiety, and I told my patients that I was very nervous. And they said to me, “Dr Hill, if you go up and you share with them our voices, and you tell them what it’s like for us, we’re going to be here standing on the stage with you, and let you know that we’re here with you.”