Author: Alex K.
Usually, when a person suffering from an eating disorder begins treatment in a treatment center, he or she will have to follow the method of treatment set forth by that specific center until he or she is able to return to normal eating habits. The program I went through strictly followed the Maudsley Method, [sometimes referred to as Family Based Therapy]. While in the hospital, I was given information about the program I would be entering once I was [well] enough to live without I.V.s stuck in my arm and without strict bed rest. This was a method that I used to read about while I was sick at home and while researching how other people have recovered. It was something I – well ED – feared tremendously and never actually thought I would have to follow.
I was brought to Morristown hospital for check up, strongly recommended by my doctors and school. I remember eating a yogurt, as requested by my mom, and whipping each spoonful into a napkin and throwing it out to avoid consuming all the calories. This was something I did with oatmeal and yogurt every time I ate them. After a long wait, following weigh in and a check up, I was then transferred to Goyreb Children’s Hospital, where they had a treatment center which enforced the Maudsley family method. I was too sick to really understand the severity of my illness and how long I would actually be in the hospital. I had hopes of returning home within the next day or so. My first night in the hospital, I was able to pick my own meal, being that it was a long day and the hospital had felt sympathy for all I had gone through before. The next morning, however, was different. I was woken up at 5am to have vitals checked and bloodwork done. I went to sleep for another few hours and was woken up at around 8am, a time that ED would never allow me to eat at, for breakfast. I was given food that was not of my choosing and was told to eat it all, otherwise I would be given an Ensure drink and a feeding tube. The healthy part of my brain that was starving to death chose to eat. The first meal was a smaller meal than I would receive in the future, due to my risk of refeeding syndrome, which occurred when patients going through treatment were fed too much after reaching a severely low weight, having dangerous side effects such as organ or heart failure. My liver, heart, and hormone levels were all damaged throughout the years I struggled with the eating disorder and were monitored each day I spent in the hospital. I really understood how sick I was after seeing how thin my veins were and how impossible it was for the nurses to stick me with an I.V.
At the beginning of the Maudsley method, when a patient is underweight, the doctor and family work together to make a meal plan that will be given to the patient each day: breakfast, lunch and dinner, and, eventually, snacks. Calories are restored slowly in order to avoid refeeding syndrome. My parents let the doctor know what my healthy self used to enjoy eating before the disorder and what I used to actually not like, in order for them to decide what to feed me each day. Every meal was a challenge, as I had no say in what I ate. On top of the challenges with fear foods, I was forced to challenge my disorder with the time it took for me to eat. Each meal was to be eaten in under 30 minutes and a snack had to be finished in 15 minutes, or else I would be given the dreaded Ensure, something I always denied while going to therapy prior to hospitalization. I was so sick, that when given a 15 calorie Gatorade each day in order to get my electrolytes up, I would pour the drink down the sink while my parents left the room to discuss the next week’s meals with my doctor and nutritionist. It was very scary that the disorder would rather have had me die than be healthy and gain a few needed pounds and get my hormone levels back to normal.
I begged and pleaded to be let out of the hospital once I felt healthier (which was only a few days into hospitalization because I was given proper nutrition) and tried to convince the staff that I could be left to get better on my own. My mind was set on the fact that the Maudsley method would ruin my family and my relationship with my parents. I was deathly afraid that each meal would lead to violence (which stemmed from ED, not me) and lead to hatred towards my mother and father, which during the beginning months, it did. In the depths of my eating disorder, prior to hospitalization, I was only allowed to eat a small variety of foods, which were all low-calorie. The program challenged each and every one of my fear foods. I can remember the anxiety I got from each meal. My family would visit me during my inpatient stay and would have to leave the room during each meal. I can remember crying to my cousin, who I hadn’t seen in almost a year, after eating one chicken finger and afterwards feeling 50 pounds heavier. Little did I know that I was losing weight at first because my metabolism was being restarted. That is what anorexia will do to you: it will give you unrealistic depictions on the relationship between food and weight loss/weight gain.
Every night at 4am and every morning at around 9am, for three weeks, consisted of a weigh in, blood work, and vitals. The first few days of hospitalization, all my organs and hormone levels were monitored. My mom stayed with me each night in the hospital. I was not allowed to know my weight or the food that I was going to be given at my next meal. With each meal came the fear of gaining millions of pounds. Each patient going through the Maudsley method is restricted of all power over food and weight gain/loss. The purpose of this is for a patient to be fed properly without the stress of having to sit all day worrying about the next meal. Although, in the beginning, it is stressful for the patient to see the meal initially, after a few weeks, each meal and the surprise that comes with it gets less challenging. Maudsley method also does not allow any exercise until the patient returns to a healthy weight. I was on bed rest for the full three weeks in the hospital and could only get up to use the bathroom.
Trust is one of the hardest things with the Maudsley method. The patient needs to learn to trust his or her treatment team, which includes a doctor, group therapist, individual therapist, nutritionists, and, if needed, a psychiatrist. Trust also has to carry on outside of the hospital: at home. My parents were guided by a nutritionist to prepare proper calorie-dense meals at home. Most meals had added calories in liquids or spreads (butter, peanut butter, syrup, full fat half and half) and milks in order to be easily digested and to help me feel less full. In a sick mind, like the one I had, I was convinced that there was a certain amount of calories my parents were told to give me each day, but that wasn’t the case. Yes, I couldn’t eat too LITTLE calories in order to avoid losing weight, but once I was out of risk for refeeding, there was no such thing as too many calories a day. The main purpose was to get healthy weight back on and quickly. Each meal seemed like it could feed a family of four. It was even harder to eat because I had developed rituals that I used at each meal; however, the program also helped me to beat them. Eating slowly was one of the hardest rituals for me to conquer. I would watch the clock, and ED would tell me I couldn’t take another bite until a full minute went by. I used every second of the time period I was told to eat. To the healthy AND disordered part of my mind, this allowed my body to taste and enjoy each moment of food I put into my body because I was so used to having only one meal a day. Other rituals consisted of very small bites, pushing food to the side of the plate or bowl in order to avoid eating, and whipping off butters and spreads to avoid the extra calories. The Maudsley method focused on overcoming all of these.
The eating disorder had very manipulative ways of avoiding calories. For me and many other patients, it was harder to use rituals during program than it was at home, as, in program, we were under strict watch and had to show the staff that we were healthy enough to stop weight gain. I’m not exactly sure what made eating at program easier than at home, but for some reason, I didn’t need to use rituals or feel as guilty in the comfort of the counselors and other girls as much as I did at home. In the hospital, the toilets could not be flushed until they were checked, and we could not use the bathroom until a half hour had past after a meal. At home, it was suggested that parents follow the same rules.
While still in the hospital, the meals weren’t nearly as big as they were once I was released into the Partial Hospitalization program, but my pre and post meal anxiety was still a huge issue. After each meal, I would sit with a blank stare on my face and battle a mind full of guilt, not being phased by the help and distractions the staff tried to provide me with. The program worked on distracting the ED after meals by incorporating certain therapy’s. My family and the professionals at the program could tell when the eating disorder was present and when it wasn’t. As I got healthier, less of it was there. Time would pass by slowly in the hospital because all I would do was count down the time for the next meal. Each night, I spent, on my phone, looking at forums about recovered anorexics and message them, asking them if they had gained too much weight. This was to get clarification and put my mind at ease. My healthy self was starving and was praying for the next meal to be something delicious that I was missing out on during my years with anorexia. Although the eating disorder didn’t want me to eat anything because it thought I was going to get “fat”, I NEEDED food, and I needed it every second of every day.
I spent three weeks in the hospital, which had included Christmas and New Years. As much as my eating disorder wanted to be home during those holidays, my healthy mind WANTED to stay in the hospital. My family had a cabin trip planned after Christmas that now, looking back on, would have been a disaster for the eating disorder and those around me. I actually liked the hospital because I was getting food I hadn’t eaten in years and it was a place for me to feel at ease.
Many fears came with the Maudsley method, one being that the treatment team was going to make me way too fat or make me gain over the healthy weight my body was supposed to be at. This was a sick mind thinking. The treatment team’s main concern was to nourish my body back to health. A healthy weight was determined by multiple different factors, including a BMI chart, my mental health, how much anxiety came with meals, when my period would return, etc. Many of the girls in the program, as well as myself, believed that we were being manipulated at times by the staff as well as being fed way too much in order to make us fat. Again, this was not true.
Once I was healthy enough to leave hospitalization, I was sent home and began a partial hospitalization program (PHP). At home, I was not allowed to know of anything being put in the foods I was eating, and I could not be in the kitchen while my parents cooked. PHP consisted of three mornings and two afternoons at program – a total of five days a week. Mondays Wednesdays and Fridays, I was there for breakfast, snack, and lunch and was sent home to eat dinner and another snack. And Tuesdays and Thursday, I had breakfast and night snack at home and then lunch and dinner at program. Once a week was family dinner, where families would come and plate their children’s foods for them so that the nutritionists could correct any errors they were making. The hardest family meal was held the second week of PHP, which only included my family and the family therapist. For me, my family made breakfast at home and brought it to the program to be eaten in front of my therapist. It was the most food I had seen in a long time. This is when I knew the program was not going to be easy. After the big family meal, which was every Tuesday evening in program, was group family therapy, where families could seek help and get ideas from the other families and patients in the program.
Each day revolved around meals, with multiple different group therapies that could be replicated at home, an hour of school with a tutor (as we could not attend school yet) and yoga. The girls and I became very close. I made friendships that would forever be stronger than most other friendships outside of the program. I met girls who I could relate to, which made each day and meal a little easier.
Each meal was monitored, and before each day began, vitals and weights were recorded. We were not told our weights until a few weeks into program, during individual family therapy. Games were played at each meal to keep me and the girls distracted, and my family was encouraged to do the same at home in order to make meals as peaceful and normal as possible. For many people who have not gone through an eating disorder, I am sure it sounds odd for a meal to be so nerve-wrecking and planned out, but for a recovering anorexic or bulimic, the only way to recover is to get proper nutrition and to beat the desires of the eating disorder. The Maudsley method teaches parents how to do that so that once partial hospitalization is over, a patient can continue treatment at home.
Once a patient becomes a little healthier, and the team believes he or she can leave and graduate to intensive outpatient program (IOP), a rock ceremony is held, where a word to describe the patient’s progress is written on a rock and given to him or her. My word was hope.
Intensive outpatient meant I would be returning to school with the weight I gained while away and attending program Tuesday and Thursday afternoons. I would get to see some friends from program twice a week, which was motivation for me to continue program without an argument.
Going back to school was a struggle in itself, which took place with my specific method of recovery because I had to eat a snack before school and leave at lunch time (10:30) to go have breakfast, all prepared by my mom. Leaving partial hospitalization also meant more meals at home, which also consisted of more rituals and more anxiety, so it was important the treatment team made sure I was healthy enough mentally.
I looked forward to every Tuesday and Thursday to attend program and have some ease at meal times. Eating at home wasn’t easy. While at home, I threw food and hit my parents at multiple meals, which I regret immensely. I said things (well, ED said things) that I could never even imagine saying to my family now. I was still weighed once a week at program, to make sure my parents were feeding me enough to continue weight gain.
Now, being at home for more meals, I would try to manipulate my parents and tell my mother she was giving me too much food that was unnecessary. For the eating disorder, it was easier to manipulate my family because it knew we had stronger connections than my treatment team and I had. My parents were also more sympathetic towards me than the people in the program were. The eating disorder was much stronger at home. With intensive outpatient, as apposed to hospitalization, I was allowed to flush the toilet, and I was told my weight everyday in order to learn to cope with the weight gain and learn that weight is just a number. Another thing many patients think comes with Maudsley is a SET goal weight, which is something I clung to and was scared to death about going over. The program had a set range or weights that would make me healthy again, but there was never such thing as an exact weight and number. Eating disorders focus and get obsessed with numbers. For me, it was calories and weight. At each meal, I mentally calculated each calorie because years of counting allowed me to memorize the calories of almost all foods.
With time, I could feel my healthy mind silencing a lot of eating disorder thoughts, which actually made my eating disorder focus even more on a goal number for my weight because I was convinced I was healthy enough to stop gaining. This was a conversation a lot of the girls and I had with the counselors during therapy. We all believed that, since the disorder was not fearing as many foods and wasn’t causing as much anxiety, it was time to stop gaining weight. After each family therapy session, I tried to convince my mom to tell me what my set goal weight was. I can remember one time, after school, I had a doctor’s appointment, where my doctor told me I had to continue gaining weight until my period returned – though I thought I was already overweight. Following the doctor’s appointment was family therapy, but before that, I was given lunch. Between the lunch and being told I had to continue weight gain, the disorder was triggered, and I had the biggest outburst since beginning program. I threw my sandwich and refused to go to therapy. This was a reaction of a monster, not a reaction of a healthy person who wanted to get better. After therapy, I angrily got out of the car and fought until I was too weak to fight anymore. I, eventually, got back in the car with my mother. This is what allowed the program and my parents to realize my mind was not actually healthy enough to stop gaining weight. Now that I am healthy, I realize that I was mentally not healthy enough then. This realization is a beautiful thing.
After my insurance could no longer cover the cost of intensive outpatient, I graduated IOP and got a rock with the word balance on it. Regular outpatient included once a week therapy and a doctor appointment every two weeks to check vitals. I believed I didn’t need therapy anymore. With health, came the privilege to chose some meals. First, came snacks, and then a meal option. I actually enjoyed the feeling of surprise, not knowing what came with each meal. I’m not sure why, but it must have been my healthy mind beating the disorder. If my therapist or mom saw I was leaning towards lower calorie options, the privilege would be taken away. As time went on, I became healthy enough to eat on my own, without being told when and what to eat. The freedom felt amazing.
Although I felt overweight and that my family and program had made me gain more than I needed, I can now see that I was still unhealthy for thinking so. I was still very thin, but as I kept gaining to a heathy weight, everything, including eating, became easier. Yes, at home and with my family, the eating disorder was, and still sometimes IS, stronger because that was where I went through both the illness and the treatment. With friends, it has always been easier to eat because it felt more “normal”. When I went off to college, somewhere the treatment team wasn’t sure I’d make it to, I ate a lot more than was probably healthy for my body and inevitably gained weight. I am no where near where I want to be now, but I am able to realize that – of course, in a healthy-minded way. I am able to workout without becoming over-obsessive with the amount, and I am able to eat normally and healthily. Although the eating disorder always tries to change the way my mind thinks – which, sometimes gives me anxiety, especially when I eat something I used to not consider healthy – I am continuing to work on these adversities and live a healthy lifestyle. Yes, right now and in the future, a diet will not be the easiest thing for me to control on my own. Now that I am trying to lose weight, more stress is brought on for me than for someone who had not experienced an eating disorder and was trying to lose weight. I have negative thoughts in my head and strong urges, but the beauty of recovery is learning to manage and live with those thoughts. In college, one thing I abused was the amount of food I ate, especially when I drank, because it was easier for my mind to eat in those circumstances, which may have caused me to binge eat.
I am now done with the Maudsley method, which may be why it was easier for me to binge eat, something I had never done before. I am no longer on a strict meal plan anymore but rather was on my own. I am still learning how to eat normally. I have bad thoughts almost every day, and I am not perfect, but I am able to eat what I want and not restrict. Yes, I would like to lose some weight because I am not happy with where I am right now, but I am going to do it the healthy way, and make it into a lifestyle, not an addiction. It is the best feeling to know that I have a family who can help me when I am struggling because they were there throughout my entire recovery and know how to deal with a disordered mind.
If there is one thing that I have learned – and something that I want others to understand – it is that no matter where we are or how our bodies look, we will never actually be happy. This doesn’t only pertain to weight; it can apply to any aspect of life. We as humans are never happy with what we have. We always want more. And in my life, that is weight. I am never happy with how I look, which is a challenge I will always live with. I am blessed to have gone through a treatment program that, despite what I thought, brought me closer to my family and allowed me to meet girls who changed my life forever. Maudsley may not be for everyone, but I know from experience that it has worked for hundreds of girls who are now healthy and living happy lives.
One thing I like to use to describe how an eating disorder makes a body physically feel is how it feels for a healthy person to wake up and go a full day without eating a substantial meal. It makes the person feel in a fog and lethargic, unable to function properly until he or she eats a good meal. With an eating disorder, imagine how it feels to go months, or even years, without proper nutrition. The body begins to shut down and causes a person to be physically incapable of functioning throughout the day. That is what I loved about the Maudsley method: it allowed me to gain weight quickly enough to return to a healthy, functioning human being. It also brought me closer with my family, while at the same time, educating them on eating disorders and how to deal with them. For anyone struggling, I strongly recommend – with all my heart – this method. If anyone has any questions, feel free to ask!