By: Amanda Bacon
I’ve been struggling with an eating disorder for 23 years and not once have I felt “sick enough”.
As I’ve gotten to know others with eating disorders, I have found that I am not alone in my thinking. Over the years, I have experienced major issues with my health, my relationships, my independence and my well-being, but it never felt like I was “doing my eating disorder correctly”. Others seemed to have it figured out and I felt jealous. “Why can’t I get to that weight?” “How can they engage in their behaviors and still function?” I must be doing something wrong. I didn’t even know I had an eating disorder until three years ago because I have always minimized my struggle and compared myself to others.
This thought process has kept me stuck and away from receiving help because I have felt I didn’t deserve it or need it. Even at my lowest weight, I felt I could have done better, I could have gotten lower. The truth is that I would have likely died trying to reach a lower weight.
About a month ago I entered inpatient treatment as recommended by my therapist and dietitian. I was very angry and hesitant to go because I was at a healthy weight according to the BMI chart. I felt humiliated to walk through those doors knowing I’d likely feel out of place there. The truth was that my eating disorder behaviors were keeping me very sick and causing medical issues even at a healthy weight. While there, I was encouraged by my therapist to read Sick Enough by Dr. Gaudiani. I felt I didn’t deserve to be there because I wasn’t underweight and that I was taking up a spot for someone who was way sicker than me and needed the help more than I did.
Even though I qualified for inpatient treatment, I still didn’t believe I needed to be there. I have always based my illness on how I physically look or how much I weigh. After reading this book I realized that I was sick enough to be there and deserved the help.
Sick enough is not a size, a weight or a medical condition. Every body handles an eating disorder differently and there isn’t one way to measure the level of someone’s illness.
If you have an eating disorder, you’re sick enough. Don’t hesitate to get help--your life depends on it.
We are so excited to be partnering with The Gaudiani Clinic to host a giveaway of Dr. Gaudiani's newest book, Sick Enough: A Guide to the Medical Complications of Eating Disorders. Head over to our Instagram to enter and check out what Dr. Gaudiani has to say about the medical complications of eating disorders and read an excerpt from her new book below.
Why Medical Complications Matter in Eating Disorders
Despite jaw-dropping statistics, the tragic and nearly universal reality for those with eating disorders is that they often believe they aren’t sick enough to warrant changing their behaviors or seeking help. This is true for patients who come to my outpatient clinic, and it was true for the patients I saw at ACUTE. Denial of disease severity is one of the hallmarks of these mental illnesses. Patients may think their bloodwork isn’t “that bad,” or their weight isn’t “that low,” or they may point to the fact that they are still high achievers in school or at work.
In writing this book, I hope to establish that anyone with an eating disorder is sick enough to seek help. If you have even one of the medical issues detailed in the book, you are sick enough. If you have never had an eating disorder, but you have a disordered relationship with food and your body, you are at risk for the medical problems I describe. Sometimes it takes medical truths, challenging the false narrative of “I’m just being healthy,” to make patients realize they are engaging in behaviors that are anything but healthy. Everyone has the potential for full recovery, and most medical problems will resolve with recovery.
Using metaphor and patient-centered language, Dr. Gaudiani aims to improve medical diagnosis and treatment, motivate recovery, and validate the lived experiences of individuals of all body shapes and sizes, while firmly rejecting dieting culture. One of Dr. Gaudiani’s most helpful metaphors is “The House on Fire.”
The House on Fire, a.k.a. Combatting “I’m Fine”
Very often, patients will try and convince me that they are actually fine. (I view the word “fine” as the four-letter f-word of our field.) They feel they are not sick enough for a higher level of care, to eat the full meal plan their dietitian has prescribed them, to warrant my concern, or to change anything they are doing in their disorder, etc. They say, “But Dr. G, I get a 4.0/I’m a star employee/I can still run every day/I’m a good mom/my potassium is normal/my weight is normal. I’m fine!” This line of reasoning can sound convincing.
An eating disorder will passionately defend itself. Like an abusive partner, it can push all other close connections away. When anything threatens it, it will lash out and become remarkably cruel to the person threatening it (the therapist, the parent, the partner) and even meaner to the patient. Eating disorders scathingly whisper that patients are nothing without their eating disorder.
What’s so hard about eating disorders is that patients retain their intellectual capacity and many aspects of their emotional capacity. We would never urge someone with schizophrenia, in the midst of a psychotic episode, “Use your inner wisdom here. Are there really little green men in the room?” The psychotic person can’t access the real world. The little green men are their reality.
We all have to keep in mind that for someone with anorexia nervosa, the beliefs that food and rest will cause devastating harm to their bodies, and their perception that their bodies are wretchedly inadequate and revolting, are their reality as well. And yet reminding patients to access their inner wisdom is a key element nearly every practitioner uses in their treatment of anorexia nervosa. Where the person with schizophrenia is fully incapacitated during a psychotic episode, the patient with anorexia nervosa can competently navigate the rest of the world, at least initially. This bizarre fact easily leads family members and friends to misjudge the severity and cruelty of this mental illness.
To combat the delusion that a patient is fine, I use a metaphorical story called “The House on Fire.” Imagine that a young woman is standing outside her burning house, and the fire department rushes up. The firefighter jumps out and says, “We’re here to put out your fire!” She says, “What fire?” He looks concerned and says, “Well, your fire. I smell the smoke. I feel the heat. I see the flames.” She smiles and says, “Oh no. If my house were on fire, it would be so hot that my sidewalk would be bubbling. And because my sidewalk isn’t bubbling, I couldn’t possibly have a house fire.” The firefighters understand her to be mentally ill, and they go put out her fire.
I go on to remind my patients that there is no single marker of illness that I look at to determine whether they are sick enough to proceed with recovery efforts. Saying, “My blood work is fine” is like saying, “My sidewalk’s not bubbling.” This is an extremely important point because someone who is fine can comfortably reject what all these people are telling them about how concerned they are and can proceed with restricting and exercising. The concept of “fine” stalls recoveries.
I try to introduce these concepts the first time I hear my patient trying to convince me how fine they are, so that the next time it happens, I can simply say in shorthand and with kindness, “House on fire.” I remind them of all the objective evidence of hibernation physiology they possess, medical signs that they aren’t fine at all.