The Three Things We Must Have in Recovery - Enola Gorham

Recovery relies on learning. In order to recover from an eating disorder, we must learn new ways to think, learn new skills and learn new things about ourselves. To integrate this learning, we must be in a state of relative calm. We must also be in good physical health, feel safe and emotionally supported and be able to integrate new skills.

Have you ever been in a class or another learning situation when you felt ill, or when you had stressful life problems happening? Did you find it hard to concentrate, because you could only think about your personal problems — or your physical or emotional distress? 
We struggle in some learning situations because the human brain must be in a state of relative calm to be able to gather information, organize it and use it.
Recovery relies on learning
In order to recover from an eating disorder, we must learn new ways to think, learn new skills and learn new things about ourselves. To integrate this learning, we must be in a state of relative calm. We must also:

  1. Be in good physical health
  2. Feel safe and emotionally supported
  3. Be able to integrate new skills

The first requirement of recovery is that we are in relatively stable physical health. 

  1. How physical health aids recovery

Many individuals with eating disorders have complex medical and psychological issues. Starvation and malnutrition are common in some eating disorders. This impacts all the body’s systems — including the brain — inhibiting the ability to learn and integrate new information. 
Starvation and malnutrition impact recovery.
In treatment, the goal is to first rescue the brain from malnutrition and, at the same time, to rehabilitate other bodily systems. The first steps in recovery will necessarily include:

  • Stabilizing and normalizing nutrition 
  • Stopping eating disorder behaviors (restricting, purging, binge eating, compulsive exercise)
  • Stabilizing one’s nutritional status to improve their physical health

For those with serious weight deficits (including patients with anorexia), weight restoration will be necessary to support recovery. Weight restoration supports the brain’s ability to learn and supports rehabilitation of all other body systems 
Stabilizing one’s physical heath and nutritional status is just the foundation of the recovery process. Once physical health is stabilized, and nutritional status is improved, patients can begin to focus on the issues that drive the eating disorder.

  1. How emotional work aids recovery

As one’s physical health status improves, and as they gain a sense of trust and support in their surroundings, they are increasingly able to involve themselves in the emotional (psychotherapy) work.
Recovery is a process of learning and self-discovery requiring a highly abstract set of skills. In recovery, we must learn:

  • How to name, notice and react effectively to emotions 
  • How to open up and speak up
  • How to take risks
  • How to self soothe and improve one’s mood
  • How to reduce symptoms of emotional distress and anxiety 

Many people who suffer with mental health problems have had the experience of being judged, criticized or of not “feeling good enough” for many years. They can often be hypersensitive or perhaps hyper-defensive.  
It is so important in recovery that one feels safe and that one can trust that they will not be shamed, judged or misunderstood. This sense of trust takes time to achieve and is needed for therapy to be most effective. Individual and group therapy supports patients through this process, helping them gain perspective on their lives and interpersonal relationships.  
Remember the state of calm — essential to recovery – that I mentioned earlier? Emotional well-being contributes to that relative state of calm. The more emotional well-being a person has, the more they can learn and utilize these new skills and this new information. 
When we feel supported, understood and safe, we can more fully absorb and utilize the skills and the processes of psychotherapy.

  1. Integrating new skills in recovery

Once a patient’s physical health is stabilized and they have achieved some emotional well-being, they become more engaged in therapy. They grow in their ability to learn and use new coping skills. When their physical and emotional health are stabilized, they can more fully utilize therapy and groups to explore their thoughts and feelings and reactions.  
As they gain the state of relative calm, they are able to gather information, organize it and utilize it more effectively. They can practice and integrate new skills that they are learning during treatment. This is the key work of recovery.

The process of eating disorder recovery

The three markers that I listed above…
1. Physical health
2. Emotional well-being 
3. Integrating new skills 
…are the key components of the recovery journey. 
So, knowing this, why do people commonly struggle to move forward in the way that they, and their loved ones, might wish? Most people enter recovery with the determination to “get it done” and “to not be a failure or a burden to others.” They want to be successful. They don’t want to fail. 
It can be humbling when we understand that all learning involves failure. This is how humans learn. The work of patients, caregivers and professionals, then, is to make room for all parts of the process while understanding that every step leads towards growth and recovery. 

Enola Gorham LCSW, CEDS is National Senior Director of Training and Co-Director of the Family Institute at Eating Recovery Center.


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