Sometimes in the midst of treatment, when you feel like you have no life or that your life is consumed by CBT worksheets, meal plans, and process groups — rather than “real life stuff” — it feels like  treatment is the problem, not the eating disorder.  After all, you may have been cruising along “just fine” before some higher level of care entered the picture… maybe getting straight A’s in school, being a star athlete, the VP of a company, a mom who seems to put together… and then suddenly you’re whisked away from your tightly-controlled world, and everything feels like it is falling apart.  Well, in a lot of ways, it is actually falling apart.

1. Work or School — You have to figure out a leave of absence, explain to others (either truthfully or with some kind of really good excuse) just where you’re disappearing to for several weeks / months.  Actually, legally you don’t have to give them ANY details — but good luck with that, especially if you are in high school.  And then you have to wrap up projects, make plans for how you’ll deal with classes the rest of the semester, distribute your work to other people in the company (which of course makes them really happy)… and basically get your affairs in order.  Whatever stage of life you’re in, leaving your job, school, family, etc, is really stressful.

2. Relationships — Going away to treatment (or evening doing something like day treatment that keeps you from filling your regular familiar / friendship roles) is really hard on the ones around you — the people who are closest to you.  It might be a shock when they first find out that you’re actually really sick and need intense treatment, since you’ve seemed so put together and perfectionistic.  And then, as if that’s not enough, now that they are aware of the issues they have to watch you struggle… whether they can physically see the symptoms or not, it’s hard to watch someone that you love hurt themselves.  And even though you’re in recovery, we all know that’s not perfect and you’ll have slip-ups — which are heart-breaking for them to see.  Your not being there to take care of your regular responsibilities, play your role in your family, or be there for your friends when they need you, creates an uneasiness.  Dealing with the eating disorder, depression, or whatever it may be, is extremely draining on everyone around you.  It’s hard for those who haven’t struggled with some kind of mental illness or addiction to understand why treatment doesn’t just cure you or why they personally can’t just fix you themselves.  Actually, what’s probably the most confusing and frustrating, is trying to wrap your head around why you can’t just get over it on your own.Additionally, your loved ones will learn more and more about eating disorders — which is a good thing, because education is a powerful tool and really important in their role in your recovery.  At the same time, though, they’re slowly going to find out more about what you have struggled with, what secrets you have kept, what lies you may have told, how long this may have been going on… and other really touchy subjects.  Personally, while Ive always received some amount of sympathy from others (especially from friends), there is also a lot of anger, frustration, a sense of betrayal, and distrust.  I can only imagine that it feels dishonest and deceitful to find out all of this information about what was going on behind their backs — and that has to generate a lot of hurt.  Not just hurt because you weren’t honest, but also that you didn’t trust them enough to go to them with your struggles and trust and rely on them.  Instead they had to find out in an unnatural setting (therapy or a treatment facility) and possibly from a stranger (your therapist).  I’m sure they would have much rather heard it from you.
3. Finances — In an ideal world, money and insurance wouldn’t be a factor in recovery.  Money would grow on trees, clothing at Anthropologie would be affordable, and my dogs would live forever (seriously, that’s going to be a real issue with me with me when they get older!  But I digress…) People would stay in treatment until they were in a good play and ready to discharge.  Professionals wouldn’t have to waste so much time arguing with insurance companies and filling out tons of paperwork to stay in-network or to keep you as a patient.  Sadly, we are so far from that right now.  The length of treatment is mostly controlled by insurance companies (well, and non-compliant patients who sign themselves out AMA), and I’d estimate that more than 50% of patients in private residential treatment (in the US at least) have to discharge prematurely.  Sure, there are financial options out there, but even with sliding scales and grants, treatment still causes a lot of financial strain.  Families take out loans, pull from savings, borrow from others — and their commitment to doing whatever it takes to keep you in treatment is admirable.  I know that I’ve spent too many nights on the phone (while in residential treatment) on the phone with my husband, arguing about the cost-to-benefit ratio of treatment.  Is it worth how much we’re paying out of pocket?  (and my answer always changed depending on the day… thursdays I had great groups and individual therapy, whereas absolutely nothing happened on the weekends and I spent a lot of time crocheting.  which is probably not worth $1500, especially since I never got any better at it).  I was fortunate enough to be able to reason with my insurance company and go into treatment prepared to pay for a decent amount of it, but a lot of people have to go home to messy financial situations, which just create more stress on top of the three thousand other things that you’re hit with once you’re discharged.  It can wreck families.

So all of this really does make treatment seem pretty evil, huh?  There really are a lot of cons to traditional residential / partial hospitalization programs, and thankfully there are newer therapies like family based treatment and Maudsley out there that are more “home-based residential” (in my eyes, at least.  you can totally disagree with me if you’d like), that help to avoid a lot of the problems that I just mentioned.  I really don’t know if the treatments were developed to avoid residential stays (clearly I’m not expert on the subject, and need to do some researching of my own), but they have shown a lot of success… and while they still cause a LOT of strain on the family and the loved one struggling with the disorder (and maybe even the financial part too, if a parent has to stay home from work to eat every meal with the kid), I’d guess the severity of the problems is probably lessened.

Still (and regardless), my point remains the same — you can’t keep up that perfectionistic lifestyle that you were living forever.  Maybe it was working for you at the time… the stars happened to align or you got the best fortune cookie ever… but eventually you start into that downward spiral (in fact, you’re already in it), and it just gets harder and harder to do what you need to do.  Eventually you crash and burn… and then not only do you have to deal with all the treatment stress, but you may get a short hospital stay before you higher level of care and you definitely freak your friends and family out.  There goes that image of being mentally stable.

And you know, you’re really not present in your life when you’re stuck in your disorder anyway.  Regardless of how function you are (or think that you are — again, I’d argue with you), you’re not getting the joy and the satisfaction out of life and the memorable situations that you would be otherwise.  Maybe you feel like you’re connecting with others and you have close friendships, but you don’t really know what those deep connections feel like until you’re doing better.

So, moral of my very long story — you can blame treatment all you want for messing up your life — because it does.  It creates total chaos and shakes it all up (note to self: is that necessarily a bad thing?  maybe you needed it to be shaken up…).  But, ultimately you made the choices to land yourself there.  I’m not saying that eating disorders, depression, and other mental illnesses are just choices OR that there is anything wrong with needing a higher level of care.  I truly don’t think I’d be alive today had I not done residential treatment (several times), had the structure of PHP or IOP during hard times in my life, and had the support of professionals who didn’t give up on me and cared even when they didn’t have to.  It does take a lot of courage to seek out further treatment, make so many sacrifices, be so honest with others around you, and face the inevitable consequences… because deep-down you know that you need the help and that you’re not going to move forward without the help of more treatment.

I just want to make it clear – treatment didn’t cause the problems or the scarifies that you’ve had to make in your life — your eating disorder (or other mental illness did).  Each decision you make is a decision for recovery, maintenance, or the disorder.  All those little decisions add up, and you end up somewhere after awhile… whether it’s in recovery and living a fuller life, in limbo and doing the chronic anorexic thing (just managing symptoms, possibly forever.  Who knows, maybe you’ll be showing your therapist pictures of your grandkids someday), or living your life in and out of treatment centers… assuming the disease doesn’t kill you (which, not to be morbid, but if you follow this path forever, it probably will).  So, your therapist didn’t put you in a higher level of care.  It’s not your dietitian’s fault for “telling on you” for not following your meal plan.  Your psychiatrist can’t do much (or anything) if you refuse to be compliant with medication.  YOU put yourself in a higher level of care of treatment.  You chose that path.  You can change that path around any moment.  I just don’t want you to fall pray that it wasn’t “your choice” to go to treatment.  Even if you’re an adolescent and your parents “made you go,” your still essentially chose to act on symptoms, which gave you some control over going or not.  I’d say the only real exception to the rule is younger patients who don’t have a concept of recovery or the skills / tools necessary to do anything different.  Personally, my first time in treatment I was majorly confused.  I didn’t understand that “normal people” ate that much (I grew up in a very eating disordered family), I really just thought I was perfectionistic, I had no concept of boundaries and what was and wasn’t okay for how males could treat you… and the whole experience was eye-opening.  But now, as an adult, I know when I’m making the wrong choice.  And I know that ending up in a higher level of care could ruin my future, my marriage, my ability to have children, my life as I know it, and just… everything. And still, I make wrong decisions.  I don’t blame it on treatment, though.  I know that’s just how hard it is to recover.