Many People have been struggling for years with an eating disorder, the women who participate in an intensive therapy in an idyllic place in the Garvey. This is not about a healthy weight, but about the feelings behind their compulsive behavior. ‘If you do not dare to say no, anorexia is sometimes the way you define your boundaries.’
The long breakfast table is covered with homemade bread, cheeses, jams and other toppings, muesli, fresh fruit and yogurt. Bread rolls are spread with butter and peanut butter, glasses of fresh juice are poured, and the plates become empty. Nothing betrays that at this table there are ten women between the ages of 18 and 45 with a stubborn eating disorder: anorexia, bulimia, binge eating disorder or a combination of the three. This beautiful converted farmhouse in the middle of the Algarve is the setting for a very intensive therapeutic stay of a month that can force a breakthrough. We can watch a few days and the program is just over half.
“I never eat breakfast at home,” Sarah says as she snaps a sandwich inside. She has been bulimia for twelve years. ‘Around eleven o’clock I started with binge eating and then vomiting. And I did that six times a day. I had no rhythm at all. ”
The Human Concern Foundation, which also offers treatments for eating disorders in the Netherlands, started this Portuguese program a year and a half ago; it is especially for people who have been stranded in treatments in the Netherlands and often struggle with their eating disorder for years. The four-week treatment program promises to even mean a changeover for them. The difference with other intensive treatments? The focus is not on mandatory eating and schedules to gain weight, but on stimulating the internal motivation of the client. As a result, healthy eating habits and healthy weight are achieved in a more natural way, and that makes them stick, so is the belief.
New relationship with food
This conviction and vision comes from former anorexic and bulimic patient Carmen Netten (45), who founded Human Concern ten years ago. After fifteen years of having struggled with her condition in her regular care, she figured out how to improve. In this way she managed to heal herself, became a psychosocial therapist and mental health professional and decided to work for others, with her experiential expertise as the greatest strength. Like them, all other practitioners at Human Concern have overcome an eating disorder.
In the four weeks in Portugal, different aspects of the eating disorder are being worked on at the same time, such as self-image, honesty and openness, and contact with one’s own feelings and one’s own body. And building a new relationship with food: eating out of curiosity or need, because it is fun, tasty and cozy. Not because it has to, but because it is allowed.
There are guidelines about food. In addition to breakfast, lunch and dinner, everyone eats three snacks. You are supposed to empty your plate, but there are no sanctions if you do not. This fits in with the vision of Carmen Netten: someone with an eating disorder has to take responsibility himself, from a desire and desire to recover. What is imposed from the outside, only meets with resistance. However, there is talk about the feelings behind your decisions. Because there is the key to overcoming an eating disorder.
Once a week, everyone determines their ‘food challenges’. Three girls are sitting in the sun under the big pine tree. “I want to choose more for what I want instead of what the eating disorder wants,” says Madeleine, a thin girl with long blond hair. She has anorexia. ‘The eating disorder wants me to eat only jam, because that is fruit with a little bit of sugar. But today I have eaten cheese on bread for the first time, because I really like that. “Almost everyone with an eating disorder has ‘banned’ products and ingredients. One is afraid of peanut butter, another finds chocolate paste and other sweets ‘unsafe’.
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‘More often for unsafe choice’ comes back to the three women. And that is also encouraged by the therapists. Experiment with different behaviors and other tastes, vary more, go beyond the strict rules of the eating disorder. And especially sharing with each other what your feelings are, your fears, your thoughts. This prevents the eating disorder, which prefers to operate in the sniffer, to take over from you again.
That’s why there is also open talk about so-called ‘back doors’, almost unnoticed, tricky tricks that the eating disorder pulls out: secretly grab the thinnest sandwich, the yogurt cup not completely empty in your bowl, always go swimming because you’re so called hot – many women here we have to move and exercise at home for hours per week and sometimes even per day, but that is not allowed during this treatment. In the second week of the program, the clients used plenty of back doors, they found themselves. But yesterday everyone told his sneaky things. Who wants to look his enemy straight in the eye must take him out of the shadows.
With a broomstick
Openness is one of the important pillars of the program. The women have therefore written letters to parents, partners and other lovers. These are read by the therapists and then discussed in subgroups spread throughout the garden. Do the participants not do something that the eating disorder actually maintains? Are they completely honest, for example, about what is really going on? Often no one knows the raw, filthy, painful truth, except the one with the eating disorder itself. Suicidal thoughts, the violence with which they sometimes go, the lies.
A girl confides to me: “During my binge eating, I ate two big shoppers full of – in part stolen – messages. Whole breads, chocolate bars, bunches of raw vegetables, jars of peanut butter, everything. Until my stomach had reached the maximum size. And then I used a broomstick to stick in that heavily tensed stomach and poke until it came out again. I do not know what damage I have done in my body. Whether my intestines will ever function normally again, or whether I can still get pregnant. “She also told nobody the details at home.
After the discussion, almost everyone will rewrite his letters. Now the uncensored version, without poetry, without smoke blinds.
Disorder as a lifebuoy
Founder Carmen Netten also calls an eating disorder a right to exist or identity disorder. ‘The essence is that you do not know who you are. The authentic part of the personality is covered under layers of debris and misery or simply not sufficiently developed. “That does not have to come through education, she assures. ‘People with an eating disorder are usually over-sensitive people with a great sense of responsibility who take care of others on their neck and are perfectionists. They adapt to expectations and lose themselves. In food they seek a form of control and right to exist. The eating disorder has a function for someone. That is why you can not just take someone’s eating disorder off; it is the lifebuoy for someone who is not sufficiently anchored. ‘
Investigating what the functions of the eating disorder are is therefore an important part of Human Concern therapy. For example, anorexia can be a way to indicate limits for someone who can hardly say no in daily life. Those who can not express their emotions well may break into a feeling of relief. Those who learn to set limits in a healthy way and express emotions will no longer need the eating disorder.
Netten: ‘Treatment without tackling the core encounters an enormous amount of resistance, and I understand that. We respect it if you are not yet able to let go of the eating disorder, but then go and search together for what is possible. ‘
That is why there is no point in merely combating symptoms. It is important to discover what is hidden under the eating disorder. What interesting information is hidden behind it, which part of someone’s ‘being’ has it protected? Once it was useful, but now it is no longer effective. ‘That’s why we do not see the eating disorder as an enemy, but as an ally and source of information. You get to know yourself very well because of the eating disorder. And that is important to get a grip on your own life. ‘
Keep each other sick
The next morning at half past six in the morning, Sarah is weighed. She enters the nurse’s office, undresses and stands on the scale.
- 61.2 kilos. A heavier one than the last time, two days ago.
- “How is that ?,” asks nurse Valerie.
- “Cunt,” Sarah replies. “I can not make more of it.”
She arrived at 2.5 kilos in the last two weeks. And that is relatively much. But that can happen if a body that is disrupted by an eating disorder regains normal nutrition. ‘After twelve years of bulimia, it no longer knows what to do with food,’ says nurse Valerie. “Sarah’s metabolism went up.”
“I’m afraid I’ll fall back home because I’ve arrived,” Sarah confesses. ‘It is very normal that you are angry or afraid,’ says Valerie, who also had an eating disorder. “You can feel like that after twelve years. Your eating disorder is not gone in one go. But if you see how you are now, compared to when you came in: you were gray, almost blue in your face, you could not move a leg. You were very sick, your whole body was in the stress position. You now arrive, but you do live. I am convinced that your weight will stabilize. “They say goodbye with a hug.
Later that day, Sarah says that the conversation with Valerie helped her. That extra us does not determine her whole day, as she first feared.
All practitioners at Human Concern, except for a doctor, psychiatrist and nurse, are themselves cured of an eating disorder. They call it ‘experience professionals’ here, because they have also undergone therapeutic training, and are trained in the professional use of their personal experiences.
Learn to taste and enjoy
In mental health care, the phenomenon of professional experience is viewed with suspicion. ‘A therapist should keep a distance from the client,’ says Carmen Netten. ‘We create a more personal bond, because our therapeutic work really comes into being. In that respect, we set out on slippery ice. But it is here that the most profit can be achieved. In normal clinics, clients quickly feel that we are “against the therapists”, so that they support each other in a negative way and keep each other sick. Here we do it together in mutual trust. In Portugal we plan a few times a session where we tell something about our own struggles, but also our turning points. There they get a lot of hope and faith. And trust: in us, in recovery, and most importantly: in itself. Contrary to popular belief, you can overcome an eating disorder. ”
Research by the University of Leiden shows that the Human Concern approach has positive results, and that recovery will last at least half a year after the treatment. Very often ex-patients eventually even work as a therapist at the foundation. As Denise Schneider intends. She came to Portugal with anorexia in the spring of 2012 and is now, well over a year later, back in the same place as intern psychology.
An important element of the treatment in Portugal is to let women deal with food in a positive way; to let them enjoy again. For example, there is garden therapy, in which they get to know different vegetables and herbs in the vegetable garden of the farm, and put their senses to work. How does sage smell? How does tea taste from verveine leaves? And what does an eggplant look like when it is still hanging on the plant? They also go to the market, where the British house cook Vere Ellis tells about the fish, local cheeses and fresh vegetables they see there. Watching and helping in the kitchen is stimulated.
Today a game is being played at a picnic spot on the banks of a river. Vere has brought containers with ingredients that the women have to taste blindfolded one by one. Then it turns out how difficult that is for some. Parsley is mistaken for coriander, muscat salad for piccalilli. “Describe the texture,” encourages Vere. “Is it bitter? Sharp? Soft? Crispy? Hard? “In the end, there is also a lot of good guessing: dried fruit, pickled cherries, grated cheese, sunflower seeds. There is laughter and when the boxes open everyone wants to smell and taste.
Today the women read in front of the group the letter they wrote to themselves and that begins with: “I believe in my recovery because …” This can mean a turning point, Carmen Netten knows. The letters are powerful in content and tone. With most women, something is buzzing again. After thirty years of fighting her condition, Judith now believes for the first time that things can be done differently: ‘The road to recovery is so much nicer than the way of the eating disorder. I feel liberation. I feel like living at home with my family. To eat together at the table again. I can cry from happiness. But I also know that this feeling can be temporary and that I need ways for those difficult moments to prevent me from falling back. “She sounds resolute:” I feel I’m coming.
“This is an astounding asset for anybody working with people battling from cluttered eating examples or dietary problems. As a recuperating future clinician, I observed the substance to be exceptionally reassuring and strong for those in recuperation. The creators adopt an all encompassing strategy to treating the patient and don’t prescribe “win big or bust” procedures or orders with respect to calorie tallying or supper arranging dependent on strict regimens. They additionally examine dimensions of consideration, weight checking and reclamation, family-based treatment, and the significance of considering activity and development in the recuperation plan. I would very prescribe this book to therapeutic experts and guides, and maybe to families and even grown-ups in recuperation (such as myself; this book has significantly affected my recuperation decidedly).”