Normal* is as Normal Does: A Philosophy
Updated: Dec 15, 2019
The video to accompany this post is here.
A common thread I encounter among families who have been in the fight a long time (often following a pattern of getting to a much-improved place, being advised to jump straight back to normal by releasing control to their child immediately and quickly, then experiencing a fast or slow backward slide and often repeating the pattern multiple times), is clinical advice on what I call "aspirational normalcy" or the theory that "If you build it, they will come" (spoiler alert: they probably won't).
"Aspirational normalcy" means assuming that if you give an adolescent or young adult the freedoms normal for their demographic, they will be driven to recover from their eating disorder. I believe the truth is almost always that until they recover from their eating disorder, they cannot and will not be and have normal.
Given that eating disorders have appallingly low recovery rates by any measure, it always surprises me more people aren't given the advice we were: this is a long-term fight and one that requires you use all the tools in your arsenal to battle. Long-term support, supervision, and accountability plans are vital for prioritizing mental and physical health and everything is potential leverage toward full, lasting recovery.**
We know that exposure therapy (formal or informal) is an important part of recovery and that eating a wider variety of foods is associated with better outcomes, so it makes sense to harness your child's desire to go back to normal to "level up" on insisting on normal behaviors around food, dress, etc. when engaging in the normal activities.
This can look like requiring popcorn eating at the movies, wearing shorts instead of sweat pants to the beach with friends, demonstrating the ability to deal with surprise late-night pizzas before going away to college, eating ice cream if you work at an ice cream parlor (this one is personal), etc.
I once had a conversation with a clinician skeptical of the level of oversight I had with my ill daughter at 17, and my response to the criticism of my approach (because it was normal for my daughter to be doing X, Y, and Z independently at her age) was to respond, "You know what else is normal at 17? EATING WITHOUT FEAR!"
I know that as a parent there is a strong pull to not cause any additional or further distress, and the relief when they actually want to get back to their lives is tremendous, and I believe we need to balance that (with finesse) with the reality that an eating disorder not fully extinguished through full rewiring by eating and behaving normally, is an eating disorder that needs only a strong wind to turn it from embers into a raging fire once again.
Tabitha Farrar, a Recovery Coach who focuses on rewiring the brain through normalized behaviors, has one of my all-time favorite recovery lines: "If you don't want an eating disorder, eat like you don't have an eating disorder." It's both not that simple and, in some ways and for some people, it can be that simple. I think we can extrapolate that to our parenting of our dependent kids - we need to do our part to help them eat and behave like they don't have an eating disorder, and we need to avoid doing anything that makes it possible to inhabit the facade of a normal life while clinging to their eating disorder.
Letting go of normal now, and often for an extended time, can be the most powerful driver of the building of a new, and incredible, normal - and THAT is a place and reality we all want to inhabit.
*In most cases I do believe that "normal" is really only the setting on a dryer and it is a useful shorthand term for the daily activities that make up our lives.
**There are no guarantees and families can do everything right and not have a good outcome; eating disorders are complex and devastating illnesses.