Monte Nido River Towns Primary Therapist Joe Sciarretta, MSW, LMSW brings enthusiasm, truth and an appreciation for the challenges his clients face to his therapeutic practice. In this week’s blog post, Joe explains how Eating Disorder Selves develop to ultimately interrupt life, and how the whole person is uniquely cared for at Monte Nido. Special thanks to colleague Elizabeth Parks, MSW, LMSW for her thoughtful editing assistance.
At the heart of our treatment approach at Monte Nido is the idea that our clients are fighting a constant battle between two parts of themselves: their “healthy self” and their “eating disorder self”. The healthy self wants to stop using the eating disorder as an escape, lead a normal life and can see the eating disorder for what it truly is. On the other hand, the eating disorder self wants to cope with life by abusing food, losing as much weight as possible and denying the seriousness of the illness. This ever unresolved conflict between these two parts of self creates everyday inner struggles and arguments: “Do I go out to see my friends tonight, or do I stay in and purge to work on my stubborn thigh gap?”; “What’s more important: being skinny or being in school?”, “Do I risk telling my team about going off my meal plan, or do I keep it a secret as long as possible?”
As an eating disorder self progressively emerges victorious in mounting numbers of these mental sparring matches it grows in power, and over time, clients eventually lose relative touch with their healthy voice. Living long enough with an omnipotent eating disorder self, clients tend to forfeit a sense of who they really are and they begin to define themselves as “a sick person” or “the crazy person with the food problems”. As eating disorder selves continue to encroach on life’s territory, relationships fall victim. Essential connections become faded and frayed as loved ones stop trying to meaningfully relate after persistently being put second to the eating disorder. Soon, interests and ambitions have to be given up due to the debilitating consequences of prolonged symptom use – “I’ll do that road trip after I recover, so maybe I’ll come back to the idea in a few years. I’m just not ready yet,” clients say.
Ironclad commitments made to one’s self on one’s worst days to “finally kick this weird thing I do with food” turn into a series of broken promises, and years unwittingly spent obsessing over calories and weight. During unpredictable moments of clarity, as clients honestly and accurately examine their reflection in the mirror, they find that they are unable to recognize the person looking back. The eating disorder self has seemingly routed the healthy self, like how whiteout eclipses a misspelled word. They feel that their disorder is their identity, and that this once-removed “healthy self” has been irreparably broken. They feel that all that is left of them is an anxious, depressed, angry, hungry, selfish, weak, hollowed out human. “Why bother recovering?”, our clients usually ask, “All that’s left to recover is whatever scraps of me the eating disorder left behind, and honestly, that’s not a person worth bringing back. What kind of life would I have to look forward to?”
This is the state our clients usually arrive in when they start treatment: a superpowered all-encompassing eating disorder self and a faintly detectable healthy self. Upon admission, our clients often haven’t eaten a normally portioned meal, in a normal way, in months or years. At this point in a client’s course, the decision to use an eating disorder behavior is as simple a choice to them as putting one’s shoes on is to a person who doesn’t have an eating disorder. That’s a bleak place to begin, but OK, if that’s where we’re starting then that’s where we’re starting. As clinicians working in a team setting, we join with our clients and meet them in the midst of all the madness so that we can get down to the brass tacks of being helpful. To help someone in the middle of a raging eating disorder is a tall order. How, exactly, can we help? What can another person do to help someone that openly strives to do harm to themselves?
At Monte Nido, we aim to help in a unique way that gets right at the heart of the issue: we don’t try to destroy eating disorder selves (tempting as it may be), but instead, we pour all our effort into strengthening someone’s healthy self. Our philosophy is that a strong healthy self, not the direct acts of clinicians or loved ones, is the only thing that heals an eating disorder. Healing at Monte Nido is about a “reintegration of selves”. Simply stated, the healthy self replaces the eating disorder self by fulfilling its purpose. We condition a person’s’ healthy self for this monumental task in many ways, all of which are what you would expect from an eating disorder treatment center: we normalize eating, offer regular group and family therapy, provide nutritional counseling, psychiatry, and nursing support, as well as one-on-one sessions with therapists. These are the foundational basics, and they cannot be done without, but they are not what clients tell us is most helpful. The Monte Nido “fairy dust” (as we call it), and what helps most when trying to rebuild a healthy self, is this: we help clients find their soul.
Before I say anything else, let me plant a flag in the ground and say that I was a tough skeptic when I first arrived at Monte Nido. “Soul”, I used to think, “what a bunch of hippies. I don’t see how kumbaya is going to make any of this better.” But, over my time at Monte Nido I’ve had my mind changed. I’ve seen people sort of wake up again. It’s hard to describe, but you know it when you see it. At first, it only happens in brief flashes, but I’ve watched people come back to their senses, as though they had just crawled out of a long foggy hibernation. But the healing process isn’t about just stopping at someone’s historical baseline. We truly aim to take it a step further.
When we ask our clients “How did we help you? What did we do that really got through to you? What made you ‘wake up’?”, they give some surprising answers. What I hear most often in response to these questions is that we helped our clients find themselves again – their healthy self, their true self, or what we more aptly call a “soul self”. We reminded them of who they were before all this happened. We talk about not just what clients are recovering from, but what they are recovering to. We rekindle soul selves by talking about love and how to find it. We create sacred moments of silence and awe where we appreciate the simple pleasures of breathing and feeling our hearts beat. We honor people for showing up and paying attention in treatment, however long their stay with us. We openly model through the true-life stories of our recovered staff what the process of getting better looks like, feels like, and how it all comes together. We say the truth without judgement. We understand that not everyone wants recovery, and we compassionately respect each person’s right to choose how far they want to go. We witness people for who they are, regardless of their symptoms. We see the person beneath the illness. We slow down, then stop. We feel deeply what there is to be felt. We drop in. We connect.
After recently co-facilitating a few Body & Soul groups (our version of a body image group where we speak little of bodies themselves), I have come to better appreciate what we “do” at Monte Nido, and I think we “do” something more than simply “strengthening a healthy self”. Through our focus on human connection and what is sacred, I think we provide CPR for the soul. We witness the true spirits of our clients and help them see what they, and only they, cannot see: the vivacious, loving, loveable, competent, passionate, brilliant, sensitive, perfectly imperfect, and sometimes emotionally messy person that was there all along, but that had merely been overlooked or unjustly doubted. After working with many clients, I firmly believe that inside every person struggling with an eating disorder, there is a soulful human being eager to not only end the unwinnable food fight, but to find a purposeful life (this applies most of all to those who feel they are the exception to this phenomena). Finding and building that life requires food, patience, love, honesty, and a little bit of fairy dust: all of which are abundantly on hand at Monte Nido.
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