Client-Therapist Script and Instructional Tool for Utilizing the Adapted to Famine Theory In-Session
Note: This is an e-mail exchange between therapist and client that illustrates how to use the Adapted to Famine Theory.
Client: It’s funny because everybody has days where they feel “fat” right? But I wonder how much thought they actually put into this feeling. Me, well, I am actually trying to think deep about it now, not sure if that’s the right thing to do or not, but I’ll try.
Therapist: Thank you for sending me this. I think it is the right thing to do, to try to figure out what all you feel and want.
Client: Ya see, some days I think “wow I look so much healthier” and la la la. Sometimes I will go work out and feel great and then the second after I eat dinner I feel like I ruined everything.
Therapist: Isn’t it confusing. You have two minds. One is celebrating your health and one is still hooked into the anorexic mind.
Client: I guess what I’m trying to say is that I don’t think any of it actually has to do with feeling “fat” I think I just miss the feeling of being…empty?
Therapist: Yes, the anorexic mind makes one feel it’s right and good to feel empty. Empty doesn’t usually feel right, just as suffering doesn’t usually feel right. But suffering does feels right sometimes. It feels good and right to sacrifice for your baby or your teammates in a game.
Client: I really do miss it. Which is crazy considering everything that I’ve done so far has put me in such a good position. I’m playing tennis, working out, I have a lot of freedom. Overall I have been so happy. At the same time though these past…. Three or four days, all I think about is how much I miss not eating.
Therapist: Imagine how an athletic star feels when she is benched for an injury. Objectively one could think, well lucky you, you don’t have to spend your precious time practicing and pushing yourself through exhaustion, you get to rest. But it doesn’t feel that way to her. The star misses not being able to push herself.
Client: I miss my niche. My one thing that was mine. Yeah it’s easy to say “well make tennis your thing, or piano” but honestly it’s not the same kind of thing. I used to actually wake up in the morning and think “wow this is the one thing I have going for me now, look what I’m doing.” And I don’t do it for anyone else but myself, honestly I could care less if anybody else knew or not.
Therapist: What a good description of anorexia. Anorexia makes you feel like you have a special niche. Anorexia has to make people feel special—even chosen, in order for its victims to tolerate the deprivation.
Client: I guess that last statement isn’t true. I do care if people know because that is how I get help…but you get my point.
Therapist: Yes, Thank God you are now, and have been, ambivalent about giving your life to anorexia.
Client: I feel like I don’t really have anything anymore… Yes I’m happy that school is a breeze for me right now, I’m happy I’m working out every day again, I’m happy I can walk around healthy, I’m happy I don’t have to see my mom cry every day. I really am happy. But I miss my niche so bad.
Therapist: I understand. It is a major loss of meaning in your life.
Client: The past few days I have actually sort of been thinking “well tomorrow I’m gonna just have a day where I won’t eat, that’ll make me feel better.” Of course I haven’t gone through with it. But I know that this is how I usually do it. I’ll think it. Again, again, and again. Time after time I won’t go through with it, I’ll get up and say “no stupid eat breakfast” and then get on with my day, then sometimes I will say “alright let’s skip lunch” of course lunch comes around and I’ll end up saying “no stupid eat lunch” and the cycle continues. Unfortunately I don’t know how much longer and I fight myself. I don’t want to go back to being sick of course, I don’t want any of that. I want this entire nightmare to be over with and in the past. For most people it is. It seems as if it’ll never be gone for me though. How is it possible to miss something that ruined my life completely?
Therapist: Isn’t it odd? But it is the way people recovering from anorexia feel.
Client: I feel so empty though. There is not one day lately that ever passes that I don’t regret eating something I ate, not one day. It’s miserable. I haven’t changed anything. I’ve even eaten ice cream at night with my parents, and I think I’m doing it to try to make sure everything stays okay, in all reality though it doesn’t prove anything.
Therapist: I think there are two things going on here. You feel empty because of the loss of a vital mission. Remember anorexia feels vitally important because ignoring your hunger and traveling saved your ancestors lives in the Pleistocene. And you regret eating ice cream because it was one of the foods that were off-limits when you were starving. Food phobias persist because they get wired into a primitive part of the brain and thus don’t respond well to reason. They do respond to exposure. If you keep getting yourself eat the forbidden foods you will find that your anxiety fades. You are doing the right thing to get yourself to eat them however you can.
Client: I feel like I gained extra weight after the whole recovery and after I got on track I could shed the fat and even out again. I thought maybe after I started working out again I might lose a little weight, gain some muscle. But according to my weight I have stayed the same. That means I’m eating a lot, or not working out enough to burn anything off. I’m not sure if this thought is truth or just a thought.
Therapist: You haven’t been weight recovered very long. It will take a longer time to normalize distribution of fat and to develop muscle.
Client:I feel my stomach, my everything sometimes like it is the only thing consuming my thoughts. Other times I feel fine. I hate it though, because I’m pretty sure it has nothing to do with how I look, or weigh, but just the horrible confrontation I’m facing on the inside lately. I have no idea where any of this came from.
Therapist: Are you worried that being obsessed with your stomach means you are vain? Well your stomach actually is softer and flabbier than before you lost weight the first time. Remember the Key’s study? The men lost muscle, including that holding their stomachs in–that’s why starving children have pot bellies, because they don’t have enough muscle to hold their intestines in—the Key’s men first regained weight primarily as fat and stored a lot of it around their middle. They didn’t like it and they complained quite a bit about it.
Client: Is it because everything is going so smoothly? I don’t really remember what things were like when they worked out so good.
Therapist: Do you mean that you’re afraid you are making up things to be distressed about? It is normal to feel uncomfortable about your stomach. But you do have to be careful that the anorexia doesn’t use your distress to get you to restrict again. Remind yourself that the only way you’ll get your old strong stomach back is to replace the muscle that was taken when you were starving, and that only happens by never starving again.
Client: What doesn’t help the situation is that I have been really hungry lately, more than I usually am. That means I know I need to eat, at the same time I don’t want to eat too much, but at the same time what if I’m still hungry??
Therapist: Your body may need more food now because making all those depleted tissues is very expensive. It may also be that some of your satiety signals need more time to kick in. So I’d think it makes sense to eat more but go slow. But we should really ask Carla. Would you like me to forward this question to her? I think you aren’t seeing her for a few weeks, but we can check in with her by email.
Client: What happened to eating and just eating. It’s like… all of that is gone. I don’t remember the relaxation, the ease anymore.
Therapist: Yeah, we take intuitive eating for granted until it’s gone, and then it becomes so precious—and feels so lost. But it will come back. Not all at once, not immediately. But if you can feed your body like you are feeding a cherished child—if you can convince that terrified starved animal part of your brain that it no longer lives with famine by eating frequently and enough, then the intuitive eating that you knew as a child will come back. Never let more than three hours go by without eating something and never go to bed with inadequate food for that day. Then over time, maybe it will take a year, maybe more, but eventually you will notice, as you described so well, that you’re just eating with relaxation and ease.
Client: Rationally I should look at the bigger picture and see what all of this has done to me, see that just skipping one meal could have me headed backwards down the journey I never wanted to take.
Client: Seems like I can’t even look at stuff rationally because I want what I want and I miss what I miss and I just want to feel better again. I want to go back to what I know. I want my thing back.
Therapist: Of course you do. And that’s normal, to grieve for the lost sense of having an important mission and for feeling euphoric at times. Anorexia feels so right because the physical sacrifices and perseverance saved your ancestors and their band.
Client: But I don’t, I really don’t.
Therapist: I know. I know how courageous you have been in this struggle.
Client: I feel like I failed. Which makes no sense because I didn’t, I recovered (am recovering?) but I feel like I failed. The feeling is so strong I could literally just cry over it, none of it makes any sense.
Therapist: I think this must be how elite athletes feel when they lose a game. If you take a few steps back it’s silly to care so much about a game, but they care so much because once athletic prowess and determination saved their ancestors from starvation or attack. You are just where you should be. You haven’t failed, you’ve gone through the valley of the shadow of death, and you are recovering! I admire your courage, honesty and determination. Let’s keep talking about all the things that come up, however irrational they may seem.