Thursday, 17 September 2015

Maybe, maybe...a meal plan?

Change is afoot. A small change - in attitude... potentially in behaviour, but I think it might be a tiny step forward. For the first time, I'm considering a meal plan.

My eating disorder is running wild and free. It's swift and deft and no matter what I do, it's always just out of my reach. At the doctors today, I threw my arms up in the air, despairing at the lack of power I have over it. I bemoaned the absence of behavioural goals or structure, and resolutely declared disordered eating as the sole viable option for me. In response the doctor said two things: "We're looking for very small changes", and then: "What about a meal plan?" Though I've heard these words before, for some reason this time I tacked them together and a door opened in my head. I saw an alternative - a way of being that wasn't horrifically disordered. While eating 'normally' remains impossible - a meal plan just might be possible.

The internet is full of reports about treatment facilities that have stringent food intake requirements and behavioural rules. The clinic I go to doesn't work this way - at least in my experience. So long as body and brain are stable enough, they offer support and make gentle suggestions, rather than dictate or enforce. Their focus is more on the underlying psychology of the eating disorder, rather than symptomatic behaviours. As I understand it, the theory is that forcing a plan on a person that isn't psychologically ready is futile. Changes won't stick, and relapse is more likely.

At times, I have wished (and asked) for practical tools or some structure to guide me, though I haven't taken them up on the help they have offered. I met with a dietician early on in my treatment, but rejected a meal plan for a host of reasons, all of which boiled down to the fact I was in no way going to commit to eating. They also introduced the idea of food as medicine and suggested I have nutritional supplementary drinks to up my calorie intake. I listened, thought it was a sensible idea, took one home and promptly tipped it down the sink. Particularly as an independent adult, there is no way anything is going to work if I'm not ready. It has to be a choice.

Things have changed since my initial meeting with the dietician. I'm not hell bent on losing weight anymore, and although the thought of gaining still terrifies me, I accept that I need to at least maintain my weight. The problem is the way I am going about weight maintenance. It's all sorts of disordered - swinging from hard restriction to binging and purging, and it's nothing short of torture. I'm so emotionally invested in this disordered behaviour, I've completely lost sight of how to eat normally, but I'm sick to death of the madness.

Restrictive eating disorders function like scaffolding. The rigid rules and measurements fit together to provide shelter from an emotional storm. The structure, ironically, feels safe. When I attempt to leave it behind and eat freely like a healthy person might, it goes horribly wrong. I feel lost and chronically unsafe. So I need something equally structured to replace it - cue the meal plan. Rather than limiting me, its boundaries would offer me a freedom: an alternative to disordered eating.




Rather than committing full time to a meal plan designed for weight gain, I would start small, as my doctor suggested. Though I know I ultimately have to increase my weight, I would begin right at the conservative end with a weight maintenance plan. What I need is another safe space to be in, and for now, that's what would provide it. I could practice semi-normal eating. If I managed to follow it for even part of the day, it would still be a massive improvement on my current behaviour. I could think of it as a goal that can be broken into small, achievable chunks.

I have enough knowledge to draw up a plan myself, but I haven't, and I don't want to. Because quite frankly, my plans are rubbish. I want someone who is not mentally unwell to do it.

The ill part of me is nervously assessing risks, and there are a raft of "What if's?" hovering over the plan. What if, for instance, they calculate the calories wrongly and I gain weight? What if I'm still hungry even after I've eaten the food they have outlined? What if I immediately shave things off the plan and turn it into another restriction tool? What if I binge afterwards anyway or I'm too afraid to do it or my metabolism is slow or my appetite proves to be unnaturally, outrageously enormous?

If I let them, these doubts could blow up and prevent me from going ahead, but I'm pretty desperate. I've tried tackling this beast from all sorts of angles and my efforts have had little effect. I really want something to work.

I'm not keen on having my food scheduled until the end of my days. Eventually, I want to be able to eat without rigid rules or calorie counting, guided by my likes and dislikes. A meal plan is still restricting, but it's not born of disorder and actually offers hope. It's a good interim measure and has the potential to push me a little closer to recovery.





xx

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