In and Out of Anorexia

The Story of the Client, the Therapist and the Process of Recovery

Ayelet Polster, Tammie Ronen

• Publisher: Jessica Kingsley Publishers
• Year: 2001
• ISBN:
  9781846422874
• Topic: Psychology
• Subtopic: Abnormal Psychology
• Index: Psychology

Ayelet spent six years of her adolescence in and out of hospital, having been diagnosed as suffering from a severe anorexia disorder. She is now a special needs teacher. In the first part of this book Ayelet describes her personal experiences of the illness, the repeated hospitalisations and her ultimate recovery, illustrated with examples of her drawing and writing from when she was ill.

Tammie Ronen, her therapist, outlines the step-by-step progress of the therapy from the professional angle, describing in detail the decision-making and treatment considerations specific to Ayelet's life and context. She also includes comprehensive overviews of contemporary research into anorexia and of cognitive constructivist methods.

This interweaving of theory, practice and personal experience offers the reader unique insight into the reality of the illness and demonstrates the effectiveness of integrative and creative methods, and the central importance of a good relationship between the client and the therapist. The book is a rich source of inspiration and guidance for therapists and other professionals, as well as for people with eating disorders and their families.

PART I

Ayelet’s Story

On Becoming Anorexic

1

Introduction

Was I Ever a Normal Child?

People who knew me as a child, as well as those who met me later on, throughout my years at university or as I started working as a teacher, keep wondering: Could it be true? Could it be that a charming, intelligent, pretty, smart person like me was hospitalized because of anorexia, actually wished to die, and spent most of her adolescence away from the world? Knowing myself now, I also sometimes wonder. Was that really me who experienced all those horrible things? How could I have survived it and stayed sane? Have I changed? Am I a different person?

Some people look back at a difficult time and say: ‘That wasn’t me. I can’t recognize myself.’ But to be honest, I can’t say that. So much is still the same. I am the same person, with the same thoughts and emotions. But I am older and smarter, and I suffer less. I can see the first signs of my disorder in myself as early as when I was a small child. From where I stand now, a so-called normal healthy woman, looking back at the process of how my anorexia developed, I can almost say that it was inevitable, that it had to be. It was a natural process. Natural? Not for everyone, but for me, yes. A natural outgrowth from where I was, from the way I was raised, and from how I developed. When I look at the worst time in my life – in the hospitals – I don’t see that any new, unexpected behaviors or emotions suddenly appeared as if by magic. Rather, I can see all those parts of me that had been slowly growing since birth. Who could have known then that they would turn into anorexia?

Yet, as I look at myself now, I must admit that nothing has actually changed. I can’t really say that I’m a different person today than that girl in the hospital or that child before her. I am the same me. The same person, with the same internal doubts, suspicions, emotions, and thoughts. Still struggling and coping with the same issues. But how can I say that nothing has changed? Then how is it possible that today I’m a happy wife, mother, and human being? Me – the expert in suffering and pain. The miserable soul. How can it be that I’m normal? Am I recovered?

I think I know. Yes, it is the same me, the same person, the same inner materials, the same doubts. However, my perspective about the world is different now. Along the way, in all my suffering, I made a detour, acquired a new perspective, and learned to trust and care for myself, not only for others. I have learned to redefine my pain, and to express my emotions differently, but what has changed the most is my behavior. My basic thoughts remain similar to what they were in the past – I’ve only labeled them differently. I continue to be overly self-critical, checking and rechecking myself. My emotions are still very complex, still encompassing a lot of ambivalence, sometimes fears, and always the need to be accepted by others. It’s true that some of my emotions are different now: I also have happiness, fun, exciting feelings – and I’ve learned to accept all of them as a normal, healthy part of my life.

My behavior is what has changed the most. I certainly no longer act the same. Now, when I sometimes get those same thoughts and feelings – about the world, myself, evil, and fears – I can tell myself that I should never act the way I used to. And I know that I will not regress. I know that I will not be hospitalized again. I will never harm myself again.

I know now that my old way of looking at the world – the dichotomous view of good and bad, of right and wrong – does not exist. I wasn’t only bad, so I couldn’t become only good. Each of us is a combination of things. Now I can also accept that I am a good human being who has the right to live.

At 25 years of age, with a history of 7 years of anorexia, about 12 therapists, 24 different kinds of medications, and 5 different hospitalizations in 5 different kinds of hospitals, I am still not sure what was wrong. Were the hospitalizations and treatments essential? Where did my problems lie – in family, society, or me? Could I have become me, the person I am today, without being hospitalized? Perhaps I would have been a better person. Who knows? Maybe it was just meant to be. Maybe it was a kind of catharsis. A mind-clearing, crystallizing process that discarded all the bad within me, and then let me start living again, as a better person.

Sometimes I wonder: Was I conceived with these problems? Now that I’ve become a mother myself, I’ve become sensitive to my baby son and what he has been experiencing throughout the pregnancy. I believe that even before being born we feel things. We are aware of the world around us. I am sure my baby knew how happy and anxious we were for him to come into the world. Was I aware of the world before being born? Did I know about my parents’ fears, anxieties, and ambivalent emotions? Did I feel neglected or afraid while alone in the incubator? I have no idea.

I don’t know how to explain the fact that I changed but actually remained the same person. Maybe I just learned to accept myself and live with myself. Maybe what I learned most was to make peace with my soul, and with my environment. I feel good, and I enjoy life. Sometimes the thoughts do come back. Is it because thoughts are harder to change than behaviors? Is it because they are too deeply fixed within me to be changed? Is it because I want to keep something of the old me? Often, I start thinking and rethinking, trying once again to understand: Why do I have these problems, and who is responsible for them? It is true that each person is responsible for his or her own life, and for whatever meaning he or she imposes onto it. Does that imply that I, and only I, am responsible for the development of my anorexia? Yet, at the same time, it’s also true that we have an inherited set of behaviors deep inside us. So, does that mean that I inherited my anorexia? Are my family history and genes responsible? What’s responsible for my disorder – what I inherited or what I created out of my life? I guess I’ll never know the answers to that , and the truth is, although I’ve pondered them more while writing this book, they don’t weigh me down in the routine of my life.

And I have a good life now. I’m happy. In fact, it’s the happiest time in my entire life. I love my husband, my children, and I can even say that I love myself. I love my husband, who shares all my difficulties with me. We both adore our baby son, and we know we will raise him with lots of love, trust, and confidence. I am not even afraid that he’ll develop my disorders. How do I have this security? I don’t know, but something is going very right for me lately. (Tammie would probably say: ‘It’s not going right for you. You’re the one who makes it go right for yourself. It’s not by chance – it’s where you lead things. You control yourself and your world. You are doing and acting right for yourself.’) And I believe in my love and my wish to nurture my son. With love and caring, and with my husband’s help, I know I can.

I even feel very happy with my relationships with my two sisters and my parents. For many years, I had such complicated relationships with them, especially with my older sister. I used to envy her and compete with her, but now she has become a good friend. My younger sister has grown up. I always felt lots of affection toward her, but she was young. She wasn’t a part of my life, of my growing up, of my suffering. She was too young to share feelings with. Now that she’s matured, now that she’s started asking questions and has become curious and interested, we’ve become closer.

With my parents, it’s a different story. I was not an easy child. It was not easy for them to see all that I went through. I always challenged their love, their understanding, their trust. It was not easy for all of us to experience what we did over the years. Now, as a mother, I can appreciate how difficult it was for them to deal with my sickness, and what they’ve gone through. For many years, I blamed them for the way they behaved. I hope our closer relationship now will help them understand that it was part of my sickness that caused this blaming and accusing. I looked at myself as a bad human being and I saw everyone around me as bad, too. Naturally, my parents were also included in that tendency of mine to view everything as bad. I hope my children will not challenge me and will not force me to experience all the things I made my parents experience. I don’t know if I could bear it. I think it would be terrible.

Now, I am happy I have my parents. They are terrific grandparents, and we get along wonderfully. I deeply hope that my mother and my father – who both used to try so hard to hide things – will not be offended by my book. I hope they understand that all the things I say about them in this book relate not to the absolute truth, but rather to what I felt with and lived with then. I love them, and I appreciate them. I am sorry if telling my story will cause them sorrow or pain. But I feel I have to tell the truth, and my truth includes my ambivalent feelings toward them, my anger and my criticism.

Why am I writing this book? Several years ago, I told Tammie of my wish to do so. She tried ...

Table of contents

• Cover
• Half Title
• Of Related Interest
• Title Page
• Copyright
• Contents
• List of Illustrations
• Dedication
• Acknowledgement
• Prologue – Before We Begin: An Overview
• I. Ayelet’s Story: On Becoming Anorexic
• II. The Therapist’s Story: The Challenge of Treating Ayelet
• III. Ayelet’s Story: Life after Anorexia
• IV. Literature Review
• V. Guidelines for Therapists: Cognitive Creative Intervention with Anorexic Clients
• VI. Closing Remarks
• Glossary
• References
• Subject Index
• Author Index