Written by: Guest Contributor, Johanna Scoglio (she/her), M.Ed., MBA
Date Posted: March 15, 2026 9:41 pm
I have lived with an eating disorder for over twenty-five years. What began as a ripple—a quiet desire to feel in control and make sense of the chaos—slowly seeped into every corner of my life. On the surface, I appeared to have it all together, but underneath the eating disorder pulled like a ceaseless undertow. I became adept at treading water, presenting as functional while quietly being carried out to sea. Most people never saw how much effort it took simply to stay afloat.
For much of my life, I longed to be recovered—to leave the sea behind entirely. Yet the traditional definition of recovered—dry land and freedom from struggle—slipped further away with each passing year. Over time, I’ve learned that healing is not about escaping the water. It is about learning to live within its ever-changing embrace—to float, to breathe, and to trust that I will not drown, and that I no longer want to. What once felt like my greatest weakness has become a source of strength. Healing has become a relationship with the tide’s pull and release, sometimes uncertain and often challenging, yet shaped by a daily commitment to presence, perseverance, values, and gratitude.
May this letter be a companion on your journey, a reminder that you are seen, that your experiences are valid, and that even in the ebb and flow of life, there is hope and possibility. Let it remind you of the resilience and courage within to keep moving forward—gently, steadily, and with heart.
Dear Harm Reduction,
You came to me years ago on my path to become a clinical mental health counselor and quietly shifted my perspective—both personally and professionally. I first encountered you in an addictions counseling class and your philosophy was clear—minimize the harms of substance use rather than demand immediate and total abstinence. Meet people where they are, with humanity and dignity. Provide resources, education, and support so individuals can make informed choices, regardless of their readiness for change. A pragmatic, compassionate approach rooted in social justice, one that prioritized quality of life while acknowledging the complexity of human behavior.
I was captivated by the radical simplicity of this philosophy: honoring each person’s journey, respecting autonomy, building trust, and reducing stigma. You asked us to honor the healing process rather than demand that someone leap to the end of the journey before taking the first step.¹
Why was the only shoreline offered one that required a sprint across jagged rocks toward an idealized coast? Why wasn’t there space for something in between—where progress could be slow, uneven, and still deeply alive?
As I reflected on these insights, I began to wonder why this philosophy existed only at the edges of eating disorder care rather than forming part of its foundation. I felt something stir within me— the quiet, invisible shift of a tide turning before the water began to move. I thought about the people I’d met in treatment and the years I had spent navigating my own recovery. Why was the only shoreline offered one that required a sprint across jagged rocks toward an idealized coast? Why wasn’t there space for something in between—where progress could be slow, uneven, and still deeply alive?
In my mind, that space became the mudflats: a wide, silty stretch between deep, turbulent water and solid shore. It’s a place to wade, to rest, and to feel the subtle pull of change without needing to rush forward. Life thrives there beneath the surface, unseen but growing. I’m still there, sometimes floating in deeper water, sometimes pausing in the shallows to regain balance. I’m not standing on the distant shoreline of perfect recovery defined by others, nor lost in the unbroken depths of my illness.
Healing, like so much of life, is rarely linear, flawless, or complete. My recovery has never unfolded perfectly, and still I find myself surrounded by so much to be grateful for. Harm reduction, you have taught me that it’s enough to be a work in progress. You encourage me to honor my values, notice moments of joy, and anchor myself in supportive relationships and flexible tools. Through you, I only must keep moving forward, trusting that change, whether visible or imperceptible, is always unfolding. Even in the mudflats, the tide is turning. Growth is happening.
But long before I knew your language, I spent years in treatment models where you didn’t exist. Without you, every imperfect bite, every compulsive movement, every inflexible thought, every shadow of anxiety and depression, and every fear felt like proof of failure. Proof of my inability to heal. Proof that recovery would never be achieved. I often wonder how different my course might have been if you had been allowed to guide my journey instead of the rigid models that demanded a standard I could never reach.
For those who come up short, stranded again in the in-between, the message often becomes the same: I am still not enough.
In eating disorder treatment, success is often narrowly defined. There is little room for hesitation, slow progress, or the mudflats that hold so many people for so long. The choice can feel equally impassable: drown in the deep chasm of one’s illness or leap to the far shore in one impossible bound. For those who come up short, stranded again in the in-between, the message often becomes the same: I am still not enough.
For decades, I experienced treatment rooted in black-and-white thinking. Recovery was defined through rigid rules, checklists, and milestones that rarely accounted for the complexity of an individual life. Progress was often measured through visible outcomes—such as weight or meal completion—rather than emotional stability, autonomy, or quality of life.² If harm reduction had been woven into my journey earlier—your nonjudgmental, person-centered philosophy that values incremental change and long-term well-being—I might have felt more empowered and encouraged in my recovery.
Research has disproportionately focused on traditional treatment models, leaving little exploration of alternatives that might better serve people with long-term or recurring illness. Approaches that allow for slower change, personal choice, and prioritize stability over prescriptive timelines, are often dismissed as giving up or accepting the illness. Yet, for many people this approach offers a path toward sustainable well-being.³ It allows us to live, work, love, and find meaning while continuing to heal. Each person’s journey with an eating disorder is unique, shaped by biology, environment, history, and countless unseen factors. For some, the traditional all-or-nothing model may work. For others, it reinforces shame and failure. Treatment should be flexible enough to honor these differences.
Now, the deeper question becomes this: how can individuals on long journeys be supported in creating their own values-driven definition of a life worth living?
For me, the answer has been harm reduction. You offer a way to navigate shifting mudflats and uncertain tides without feeling caught between sinking or attempting one monumental bound to shore. In recent years, you have shown up in small but meaningful ways, rooted in a new perspective: living with an eating disorder does not negate living a full life. It’s a belief that challenges the one-size-fits-all path and affirms that it’s possible to find steadiness in the ebb and flow, to keep moving even when life feels turbulent, and to redefine what it means to thrive.
Research shows that eating disorders often follow prolonged and variable courses, and chronicity is associated with poorer outcomes the longer illness persists. Mortality rates remain unacceptably high, particularly for those with a protracted illness.⁴ Given these realities, supporting individuals on a long-term journey requires both skilled providers and supportive loved ones who understand harm reduction and can help tailor personalized strategies. Like the approach itself, you are multifaceted, nuanced, and flexible—yet several key principles guide your practice:
Recovery is not the distant ideal I once chased, but the life I am living now. A life built on small steps, sustainable choices, values, connection, courage, and compassion. A life that makes room for both struggle and joy. With you, harm reduction, I have a way to keep going. This is my version of healing: imperfect, evolving, and deeply human. You have taught me that staying in the water is not being stuck. It is being enough.
You are not surrender. You are survival. You are healing. You are an endless journey. You are purpose. You are meaning. You are hope. You are nuance. You are compassion. You are acceptance. You are connection. You are imperfection. You are flexible. You are values-driven. You are well-being redefined. You are possibility. You are humanity. You are living in the messy, unpredictable mudflats—held and embraced by the water—certain of one’s worth, value, and personal recovery.
Johanna Scoglio (she/ her), M.Ed. MBA, is an author, educator, mental health advocate, and nonprofit founder. She lives in North Carolina with her husband, four bonus children, and their puppy at her side.
Book website: www.shimmeringseaglass.com
Nonprofit website: www.adragonflysdream.com
Sources:
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