As promised, this is the post addressing the challenge of embarking on a recovery effort from an eating disorder while balancing trying to keep a roof over your head and/or raising young children.
A common misconception about recovery is that you can “make up” an expenditure of energy by increasing calorie intake alone. Once the body is in an energy deficient state, then no amount of upping the daily energy intake will help if you are constantly spending the intake on your day-to-day demands. A non-eating disordered woman of 24 needs 3000 kcal/day on average*. If she engages in an active job or athletic pursuits she will instinctively eat more to maintain her body’s energy balance. But for someone who has restricted her energy intake for even just a few months, the cumulative deficit is significant.
As I touched on in the blog post Gaining Weight Despite Calorie Restriction, the body has two mechanisms to for keeping you alive in the short term when you are dieting: catabolism and metabolic suppression. As soon as an energy deficit is present in the body, then the body activates these mechanisms. Catabolism is the destruction of your cells to release the energy within those cells to use on short-term survival. Metabolic suppression is the system-wide slow down (in some cases shut down) of any function deemed discretionary for your immediate survival—a common example being reproductive functions.
As a result anyone who has not met their body’s energy needs even for a short time has both physical damage due to catabolism and physical atrophy due to metabolic suppression. Reversing it requires both re-feeding and resting. If you demand too much of the living system in the middle of it trying to repair damage and restore its energy deficit, you chase a rainbow that is forever disappearing out in front of you.
Calories are not mechanistic or linear in their actions on the body. The body itself has an active role in determining how that energy is partitioned, used and managed. Certainly if you take in enough energy to compensate for the day-to-day expenditures of an active job or raising young kids, you will halt further catabolism in the body. But how will you encourage the body to return to its optimal metabolic state wherein it will actually reanimate slowed or halted biological systems in your body? The body is a zero-risk investor. In order to regain its trust, you have to provide it with an abundance of energy and maximum opportunity to use the energy as it sees fit. And in order for the body to have maximum opportunity to use the energy, you have to be resting to a degree where the energy is not instantly drawn down again by you and your day-to-day activities.
Given the reality of recovery needing to incorporate both rest and re-feeding, you have to take a good hard look at whether your understanding of “I must do this job to survive,” is objectively true. Here are the things to investigate:
Is it possible for you to find a less demanding, lower paying job that would work? Can you be given any kind of sick leave so that you can receive some financial coverage while you are handling the early phases of recovery while off work? Can you go part-time and get a roommate to cover the drop in income? Can you move or give up a car; reduce expenditures; or temporarily live back home/with a friend to make the income demands much more flexible? If it’s a toxic supervisor/boss, can you work at another location, be transferred, work in another department altogether? How supportive are those closest to you? Are they draining you as well? Do you have well developed boundaries as to what you say “yes” to, both personally and at work? It’s more the norm than not that a recovery effort ends up being a 360° life excavation and restoration project.
Many are quick to confirm that they cannot possibly quit, but when they delve into all the details they find that either quitting is more feasible, or other options for lessening the stress significantly are available. Engage on these topics with either a loved-one or therapist so that you know that you are not inadvertently using your job as a way to avoid the anxiety of resting and eating (i.e. reinforcing the eating disorder).
Let’s assume you have gone through the entire process and it’s objectively the case that either your job or your childcare responsibilities are non-negotiable. It’s still more than feasible to reach remission in these circumstances, and we have many examples of those who have accomplished this juggling act on both the Eating Disorder Institute and Uzilu forums.
To juggle either work or child raising and recovery, you have to telescope your life down to only three repetitive and grinding tasks: eat, rest and work (or childcare). It means every other discretionary activity has to be shelved. Socializing has to be done in a way that never impacts your eating or sleeping (assuming you find socializing helps to unwind you—i.e. you're an extravert). Household chores? Get good at off-loading and not doing. Seriously, if you are not at work or child wrangling, then you need to be on the couch and eating. If you have the money, hire people. If you have a partner, well then they have just been given a huge promotion to handle all household chores. If you have no money and no partner, then extended family or friends must be called in. You have to ask and you have to drastically lower your standards of what constitutes an acceptable level of tidiness.
If the dust bunnies start to head across the room in large colony formations, then try to get good at watching them as if you were trying to identify interesting shapes in clouds. You may want to treat stains on your children’s clothes in much the same way. I am only half joking. If you had a broken leg and arm, then how would the household chores get done? Well then enact that plan because you have a chronic condition that prohibits you from doing a third or fourth or fifth job at home on top of your day job and your recovery.
You ban all “shoulds” except “should eat” and “should rest”. Thankfully, eating ultra-processed and fast foods is beneficial in recovery (see here and here) so you don’t have to expend energy making meals in addition to everything else.
A life in recovery where you eat, sleep and work is monotonous. However, it requires that level of single-mindedness to allow the recovery process to get some traction. The foundation of getting ahead in recovery is saying “No.” The main reason that an active job is not conducive to a recovery effort is not always the job itself; it’s the predilection to treat all other life activities as equally non-negotiable.
We fight being in an in between state in our western cultures. We want plans and charts, getting from A to B, and measuring up to our peers and the Joneses too. However you will know you are placing your recovery at the right level of importance if most things in your life feel undetermined and amorphous. As I’ve said in other blog posts, recovery is not a heroic climb up the mountain; it’s a frustrating, confusing and sometimes downright frightening path through a maze. You need to travel light through the maze. If you bring your entire luggage set of expectations, roles and “shoulds” then you won’t get out the other side.
There are numerous cultures where walking a spiral (marked in the sand or with trimmed hedges), or making your way through a labyrinth or maze is considered a physical trigger for reflecting the spiritual experience of living life. You may have to circle back around to recovery several times over in your life. That’s not failure and that’s not terrible. You might just be at the wrong place in the spiral or labyrinth of life to get through just yet. In my first-hand experience of those navigating recovery and juggling work or child-raising responsibilities, ultimate success depends upon accepting the fact that a recovery effort is not a hobby and cannot just be tacked on to your life if and when time allows.
While this book reflects on the profound transition following the loss of a life partner, it has useful parallels for what constitutes a recovery effort from an eating disorder: The Way of Transition: Embracing Life’s Most Difficult Moments by William Bridges. It’s okay to be in the middle of nowhere with no sense of when you will reconnect with your matched luggage set of life expectations. You won’t be there forever.
* See Homeodynamic Recovery Method, Doubly-Labeled Water Method Trials and Temperament-Based Treatment for references.