It’s Christmas and we’re still Talking to Anorexia (and it’s still not listening)

So, it’s Christmas. Merry Christmas! What does an anorexic do a Middle-aged male anorexic do at Christmas? Maybe I’ll tell you later. In the meantime, here’s the rest of my meditation on Louis Theroux’s anorexia documentary:

It’s not just a cry for help, the anorexia of the women on Louis Theroux’s documentary. We need reassurance that we are genuinely ill because hunger generates its own brand of anguish. I am currently relapsing and I can confirm that every day I feel more hemmed in by a looming, baseless sense of threat and alarm. This makes me suspect anger and disdain in those around me.

The suspicion is not without cause: anorexia makes you boring, annoying and intolerant. However, my body does seem to be responding to immanent starvation with an urgent call to arms, possibly to make me do something about it. But, because I’m anorexic, I will do nothing. Soon it will overwhelm me, and then I’ll lose my bearings and sense of perspective and forget that these feelings are a response to a physical lack. Instead I’ll call them “guilt” or “fear” and attribute them to other causes, and these misattributions will then drive my behaviours. Similarly, Ipsana responds with terrified and entrenched defiance, and Janet claims that she won’t eat a tiny biscuit because of the “guilt” that comes from feeling fundamentally unworthy.

Jess, another patient, who is still losing weight replies to a doctor’s question, “how are you feeling today?”, with “quite stressed and anxious…quite despondent I’m doing this again”. She also says “I just feel a bit embarrassed, like I’ve failed, really.” “Stressed, anxious, despondent, embarrassed”: this sounds like the anguished turmoil of the starving, reduced, by exhaustion, to a blurred, uncertain whisper, even in her own mental discourse.

Anorexia appears to offer a refuge from all the complexities and anxieties of life. You don’t intentionally adopt it for this purpose, but, once you have it, hunger is so primitive and powerful that it overwhelms all other troubles. Like one of those debt-consolidation companies that promises to simplify all your debts into one. It demands attention and befuddles all other thoughts, and so it translates all other anguish into anorexia anxieties.

So Janet can say “when you’re starving you feel so bad you feel pain. It numbs everything. It numbs your thinking. You can’t think straight…When my mum died and my sister died I didn’t feel the pain. I was numb I was so hungry”. And this is why Jess’s doctor’s question is pointless. He knows how she’s feeling: survivably anxious, mournfully confused and very very hungry. Same as always. That’s the whole point. Ipsana says “I usually don’t like reflecting on things, especially like this process” Anorexia stops you thinking.

So anorexia promises a solution to all other psychological ailments: because it is simpler and more urgent, it masks other fears and anxieties.  Janet suggests that she lacked control – she didn’t want to get married; she didn’t want to grow up: “I wanted to be a child…The anorexia was my best friend because I didn’t have to do anything because I was sick all the time…It was my own little world that I could hide inside” And anorexia is also easily assuaged, temporarily. All it takes is a carefully planned meal. You may postpone this assuagement indefinitely, but it’s there if you need it.

Furthermore, starvation makes you feel anxious and fraught, so the worries you’re hiding from can seem insurmountable, more threatening, more calamitous, when glimpsed with the added exhaustion caused by malnutrition, as can the struggle to overcome the anorexia itself. The world of the well is a daunting place.

All this encourages you to just carry on managing your hunger, maintaining your soothing, self-hugging rhythms of need, and satisfaction of that need. People who are well can’t conceive of how absorbing and therefore comforting and satisfying tending to your illness can be. Louis Theroux says “It was baffling to find people seemingly so insightful and full of promise who were at the same time in the grip of something so irrational…Making it all the more strange was the way patients valued and held on to symptoms that could end up killing them while recovery was almost always viewed with ambivalence and fear.” Let me tell him: it’s difficult to give up because it genuinely serves a need and something would be lost if we abandoned it. It’s made out of us, and it serves a purpose. As Louis theroux says, “the healthier and the unhealthier impulses get intertwined so that it’s quite hard to separate the two.”

This partly explains why we can talk so calmly and honestly about it, but not throw it off; why we make such odd self-contradictory comments; why Ipsana, after putting on weight, and thus not dying, can say “the eating disorder side of me is obviously not thrilled.”

Interestingly, eating disorder specialists seem to accept this. Anorexia is a chronic condition that we may just have to live with for a while. The average recovery time from anorexia is 7 years, apparently. Ipsana’s doctor says, “We’d always encourage people to go for recovery, but if it’s too difficult we say ‘right, ok, let’s go somewhere in between: you don’t give up the eating disorder because you need it for whatever reason. It’s a way of managing something, and so we’ll help you manage things in a community so you can have some sort of quality of life”

Louis Theroux’s signs off by saying: “Anorexia is an illness associated with appearances but in my time speaking to people with the disorder I’ve been struck by how much it had to do with the deepest feelings of powerlessness and lack of self-worth. It intertwines itself with positive qualities like conscientiousness and self-discipline and makes them poisonous. Demanding from those who have it a daily heroism in facing down an illness often indistinguishable from their own selves.”

“Heroism”! Oh poo, Mr Theroux! Now you’re just trying to charm us! As Jess points out, “it takes a hell of a lot more strength to eat and recover from this illness than it does…to indulge in it.”

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