The Lonely Road to Recovery
A Conversation with Clinicians from Mirasol Recovery Centers
According to Dr. Lissa Rankin, the greatest risk factor for disease isn't diet, or exercise, genetics or bad habits like smoking. It's loneliness. Lonely people have higher rates of heart disease, cancer, dementia, high blood pressure, diabetes, infection, anxiety, depression, insomnia, suicide and addiction.
We came across Rankin's research while reviewing the results of Mirasol's alumni survey. Graduates of our residential treatment program report that their biggest challenge in recovery isn't family or relationship issues, or sticking to a meal plan, or even body image. It's loneliness and isolation. So Mirasol clinicians gathered together to discuss the relationship between eating disorders and social isolation, and what clients can do to build community and forge meaningful relationships in recovery.
- Diane Ryan, Executive Director
- Maeve Shaughnessy, Clinical Director
- Ann Twilley Garcia, Trauma Therapist
- Allison McCabe, Primary Therapist
- Don Hurst, Primary Therapist
- Sharon Davis, DBT Therapist
- Rachel Nelson, Art Therapist
- Jessica Chavez, Aftercare Specialist
- Julia Quiñonez, Counselor Assistant Supervisor
- Kim Kellow, Spiritual Integration Practitioner
Rachel: "I do a house-tree-person assessment with everybody when they come in, and I notice that when people show themselves swinging from their tree, it's like they are only relying on themselves, because the tree is the sense of self. They really don't feel like they have support, other than themselves, and they take everything on."
Ann: "Almost all of our clients have attachment ruptures. With those ruptures, there's no template for developing healthy relationships. They don't have a schema for that. So they're going to have a lot of difficulty connecting here initially, and of course connecting outside when they go home."
Almost all of our clients have attachment ruptures. With those ruptures, there's no template for developing healthy relationships. So they're going to have a lot of difficulty connecting here initially, and of course connecting outside when they go home.
Diane: "All of the research shows that insecure attachment is the number one predictor of people's self-perception of loneliness, followed by various kinds of insecurity, which would certainly reflect a lack of self-esteem. We certainly see our clients presenting with those issues. And that's probably one of the reasons why loneliness is such a big deal. It may abate some when they're here because we are able to foster a sense of connection, and we address social anxiety and social tension and all of those solutions in a group format. But I think when they leave, the structure is not necessarily in place for them to continue the skills that they learned here."
Jessica: "One of the tools that we do is 'what does loneliness feel like for them'. How do they know that it's loneliness that they're feeling? What does loneliness feel like to them? And it's different for each person."
Diane: "It's an interesting concept, because you can only self-diagnose loneliness. I can't say, 'You're exhibiting signs of loneliness, and I'm going to put that in your diagnostic.' Because it really is something that we perceive ourselves, based on different variables and different life experiences. And it's universally unpleasant. There are certainly a number of people who like to be alone, but I've never heard anybody report that they enjoyed being lonely."
"One thing that we hear a lot is, 'I don't have anybody in my life. My eating disorder has been my only friend.' So often the eating disorder and isolation go hand-in-hand. But there's a big difference between solitude and isolation. Solitude can actually be necessary in self-care, but isolation — that's avoidance. That's a medicator."
Alison: "One thing that we hear a lot is, 'I don't have anybody in my life. My eating disorder has been my only friend.' So often the eating disorder and isolation go hand-in-hand, so one of the things we try to talk about with clients is how the eating disorder can disrupt possible connections with people — buidling relationships, building relationships, building support — so that clients can realize that they don't have to turn to their eating disorder. There are other people out there. There's a big difference between solitude and isolation. Solitude can actually be necessary in self-care, but isolation — that's avoidance. That's a medicator."
Moderator: "How does isolation medicate? What does that do?"
[Everybody talking at once] "It keeps you safe and comfortable. You don't have to worry about trusting people."
Sharon: "If you've been hurt in a relationship time and time again and have attachment ruptures, then of course you would isolate, because it's the natural 'safe' thing to do. But at the same time, it's part of the disorder, so it perpetuates. Then, you may have additional symptoms, including depression and anxiety associated with an eating disorder, that can lead to isolation as well."
Rachel: "There's such a shame element from trying to hide so you can be in the eating disorder. I think that plays into this a little bit too."
Maeve: "The behavior of an eating disorder — the binging and purging — you're not going to do that in a group of friends. That in and of itself can be isolating. And maybe their friends want to go out to a restaurant, and they can't go because of not wanting to eat around people."
A big part of the reason clients isolate is because they have a fear of rejection. Coming out of isolation means that they have to be honest and real and raw and vulnerable.
Don: "One of the things that comes up for clients I've been working with is social anxiety. A big part of the reason clients isolate is because of how they perceive their place in society and social situations. They have a fear of rejection, and when they isolate, it helps them cope with their fear of rejection and their anxiety and their loneliness. Clients report that when they're coming out of isolation, it means that they have to be honest and real and raw and vulnerable. So the isolation helps keep them disconnected from themselves and others."
Ann: "Another reason to come into a community like this is that they can see they're not alone. Other people isolate like they do, and the isolation that they're all experiencing brings them together. Of course you've isolated! For all the reasons we've been talking about — the trauma, the attachment issues. Yeah, we get while you're isolated. And it's not working for you."
Moderator: "So how do we address that in treatment? How do we help them deal with those feelings and get back on the road to being able to connect with themselves and with other people?"
Another reason to come into a community like this is that they can see they're not alone. Other people isolate like they do, and the isolation that they're all experiencing brings them together.
Ann: "We start with the psychoeducation, to help them understand that those early relationships really had an impact on them. And to help them understand that they haven't done something wrong. They might be feeling shame from the fact that they're isolating or that they can't have friendships, but probably 90% of our clients tell us, "I don't have relationships at all.' So we help them to understand that that's normal in this context. From psychoeducation we go on to help them reprocess some of those old attachment wounds so that they can develop the potential to connect. And then they develop relationships here with peers and with the staff. Mirasol does a fabulous job of being warm and supportive and caring enough and holding that space so people can start to feel safe enough to do that."
Diane: "Oftentimes people don't realize that social connection is a skill, and relationship-building is an actual skill. If you've had secure attachments growing up, you just do this naturally. We are social creatures and we are designed to do this. But if you have these ruptured attachments, you don't have those skills. So one of the things we focus on in an array of different tools and skills is, 'How do you form a connection with another person?' How do you open yourself up when you don't trust anybody? And how do we build on that so you can continue to do it after you leave treatment?"
Rachel: "The primary therapist relationship is where a lot of it can be healed. That's one of the main things that it's doing."
Ann: "It might be the first time that client has experienced healthy attachment, where it wasn't tied up with trauma. This might be the first experience, and they really don't know what to do with that information. So another important part for us is to step in and help them understand these feelings and how to manage them."
Diane: "And part of the repair that needs to happen is the relationship with oneself. That's really key. It's really difficult to be in community with other people and be vulnerable and share and be exposed if you think that there's something defective and wrong about you on a fundamental level. That's one of the things that we focus on here. 'How can you feel better about yourself in your recovery so that you can begin to share yourself with other people'."
Kim: "What we find with our anorexic clients is that they come in so cognitively impaired that once they start getting some nutrition on board, they get curious. And it's always fun to see that, when all of sudden they say, 'I'm interested in this now' and the sparks start going off."
Moderator: "I often hear from alumni that they really miss the community that they had in treatment — both their connections with their therapist and other staff, and especially their fellow clients. We often say they start to heal when they bond with other clients. What can we do to help clients reestablish that sense of community after treatment?"
The healthiest clients are the ones who, at some point, get sick of the eating disorder groups. They don't want to always be identified with their eating disorder. When they start to say, 'I think I need something different,' that's really a great sign.
Diane: "Eating disorder clients are at a disadvantage when they leave because substance use clients have AA and other groups like that they can turn to, and there is no real equivalent [for eating disorders]. So you really have to go to great lengths to form those kinds of connections according to your interests and family and friends. But it's something you have to make an effort to create, because you don't have that automatically."
Ann: "What I see over time is that the healthiest clients are the ones who, at some point, get sick of the eating disorder groups. They don't want to always be identified with their eating disorder. When they start to say, 'I think I need something different,' that's really a great sign. So go do other kinds of groups, something that can still be supportive. A women's group, or at art class, or self-defense — something that uses your skills at connecting. It's important that they start to do that because otherwise they're going to stay stuck in the eating disorder, because that's the only place they've connected. So part of our job — especially in PHP is to help them create that bridge out of the eating disorder community and into other ways to be connected in the community."
Moderator: "What do you think is the most important thing for a client who's on the outside after treatment to try to remember and try to do to take care of themselves as far as establishing community?"
Ann: "I think they need to remember that it's not going to be comfortable. Even if they went through all the levels and did everything well here, it's still going to be difficult in the beginning. So just being compassionate and kind to themselves — that would be the first thing to help them to continue to do it."
Music: "Luvorène 1" by Bacalao. From the Free Music Archive, CC by NC