Yesterday the New York Times posted an article on the issue of recovery from anorexia – specifically, if full recovery is possible, and if so, what that would look like. Then today, the Independent posted an article entitled “Is depression actually good for you?” I had the exact same response to both of these articles: “WTF?!”, followed by “well…actually…”
It can be dangerous for journalists to publish material like this, because if the issue is not handled sensitively it can give the wrong impression to people who suffer from mental health problems and the general public alike. For example, someone struggling with anorexia who reads the first article might just decide that fighting the illness isn’t worth the effort if full recovery isn’t possible. I am thoroughly sick of hearing from various sources that “once you have an eating disorder you will always have an eating disorder”. If someone with a history of eating disorders is still bingeing, restricting, counting calories obsessively, unable to participate in social occasions which involve food, or subject to random panic attacks about food and weight then that doesn’t mean that recovery is impossible, it just means that those people are not yet recovered. They might be suffering from a subclinical eating disorder, or from EDNOS, or from a form of disordered eating – but merely not looking ill does not indicate that you have taken recovery as far as it can be taken. Being recovered means not only looking healthy but acting in a way which is likely to keep yourself healthy and being okay with that mentally. Maintaining a healthy weight, not counting calories, being able to participate in social occasions which involve food, not being tormented by your weight or intake, not immediately restricting or bingeing whenever you go through a stressful period, not obsessing about food or numbers – those are not impossible goals. I resent any implication otherwise.
On the other hand, if I were to write that article, I would suggest that not only do some people not recover fully due to their personal circumstances (lack of treatment or support in the community, recurrent stress or trauma, physical illness, complicating factors like that), but that the discussion over whether full recovery is possible is a lot more nuanced than that. It really depends on how you see the illness. If you see it as an expression of emotional difficulties alone, then you may believe that resolving those difficulties will lead to full recovery. If you see it, as I do, as a complicated illness in which biology and environment interact with each other to predispose, trigger and maintain the illness, then you might believe that people can appear to be fully recovered, only to relapse after a significant period of stress or illness – anything which leads them to eat less than usual or lose weight unintentionally. However, that isn’t the whole of my opinion, because it suggests that the predisposed person is a helpless onlooker. In fact, because I KNOW I am biologically vulnerable to eating disorders, I can stop myself from relapsing by taking extra care of myself when I am ill or under stress. I can push myself to continue eating if I lose my appetite due to anxiety, or seek professional support if I find external circumstances too much to cope with alone. So in either case, whether you see eating disorders as purely psychological or a combination of biological and psychological, recovery without relapse is possible. I always think the saying “It will be okay in the end. If it’s not okay, it’s not the end.” is a bit misleading, because lots of people end their lives in pain and suffering, but in the context of recovery it IS true. If you’re not fully recovered, you’ve not reached full recovery – but that doesn’t mean it doesn’t exist.
Jumping on soapbox number two: the article on depression. I do see the journalist’s point, which is that some people find that depressive episodes can act as a catalyst for change. For example, if your depression is caused by overwork and physical/mental exhaustion, then becoming depressed would show you that you are pushing yourself too hard and it might influence you to take your life in a different direction. Another point was that some people find that once the episode is over, the things they learned from the illness and recovery mean that they feel stronger and more capable of coping with future stress. But whilst those are both valid points, they are both pretty limited too. In the case of the first example, what if the depressive episode came out of the blue? What if it was merely a biochemical fuck up with no major trigger? Sometimes, if you are so predisposed and under some physical or emotional stress in the first place, tiny things can trigger lapses into anxiety or depression. There might be nothing wrong with your life, leading you to beat yourself up for “not having a good reason” to be depressed. My longest and most severe depressive episode occurred when I was studying a course I adored and felt I had found my calling in life, in a happy and stable relationship with a man I loved, had lots of friends and my relationship with my family was better than it had been in a decade. There was nothing external to change. There was nothing internal to change either: I worked so hard to avoid resorting to self destructive behaviours in order to cope. I fought my anxiety, I kept getting out of bed and going to university even though I was exhausted and wanted to die, and I talked to my boyfriend, family, friends and professionals. Regardless of this I ended up in hospital. The bad thing in my life that needed to change was the depression itself, and at the time that was not within my control.
I do feel that the point about feeling stronger for having survived may be true up to a point. I feel proud of myself for getting through all the things I’ve had to deal with in my life, and the techniques I learned during recovery for dealing with my mood and anxiety are invaluable in other areas of my life too. I think they make me more capable of coping with life as a whole, rather than just being useful for diffusing panic attacks. I have also learned a lot about myself, which might help me avoid having a midlife crisis thirty years down the line, but this is only true because I have come out the other side – it was certainly not true when I was still unwell. Further to that, in some ways my experience has lessened my ability to cope, because I am still prone to panicking when I feel very anxious or low. I am terrified of becoming severely depressed again and not being able to make myself better no matter how hard I try, and this means I don’t always cope with stress in the most effective way possible. So basically my experience with depression has made me both better and worse at coping with life, and these effects probably cancel each other out anyway 😉
If I had to summarise my overall reaction to these two articles I would say yes and no to both. Recovery is possible but vigilance may well be necessary during times of stress and illness, and depression affects a person in such complex and individual ways that it is impossible to make generic statements about any positive aspects. I had to be awkward 😛