The central purpose of the programme, at Ascot House, is really to hold you in place so you can be fed up to a healthy weight. Abi, my local NHS Eating Disorders specialist, insists there’s a direct relationship between weight restoration and having a healthy mind-set. My own experience suggests that the more you starve the more existentially alarmed and threatened you feel. This is odd, since anorexia provides you with a bulwark against anxiety, in the first place. However, the more you dig yourself in behind the protective earthwork, the more ghastly everything becomes. It looms over you. When you try to locate the source of these fears you can’t unearth anything much. Abi claims that once you’ve returned to a normal weight, many of these feelings just evaporate and you can’t remember why you found life so daunting.
Ascot House offer a simultaneous programme of therapy and workshops. These all have a similar format because they’re all based on CBT (Cognitive Behavioural Therapy)-style attempts to consciously identify, and then address, the foundational assumptions and values of your thinking. There’s a lot of cyclical flow charts with arrows going from unhelpful assumptions to negative thoughts to destructive behaviours that reinforce the assumptions. The idea is that we identify points of intervention where we can disrupt these toxic cycles. It all makes reassuring sense, although internal coherence doesn’t necessarily mean a system is applicable, or that you’ll be able to recall it when ambushed by baseless alarm, or attacked by a bear.
One of the things Dylan and I share is our awkwardness with these sessions. I suspect we both feel ashamed of ourselves, so we hide our thoughts and feelings away, even from ourselves. At the beginning of each session, we are each asked to “check in”, to say how we’re feeling. Inevitably, Dylan, lounging back in his chair will say, in slow, easy, meditative tones, “Not too bad…yeah…not too bad.” This makes me laugh because he’s usually been climbing the fucking walls five minutes earlier. He’s not lying, he’s using language to push people away. It’s a way of saying ‘I DON’T EVEN WANT TO THINK ABOUT THIS!’
Although my performance, and my motivation for it, is different, I’m similarly secretive. My defensiveness comes across as a desperation to please. I pretend to be a lovely, willing and helpful person. To assuage my guilt, I have promised myself that I will embrace this process as whole-heartedly as I can. To hide how foul I’ve been to my family, I want to be thought of as a good person by everyone else. Anyway, nothing is to be gained from resisting and then collapsing after much grief. This is a voluntary unit, so if you want to take resistance to its logical conclusion, you can walk out whenever you like. I comfort myself with the thought that I can relapse, if I want to, once discharged. I’ve proved before that I can do it.
The aim is to stop wanting to relapse, and this is a difficult and threatening idea. A stable sense of identity is vital for mental well-being, and to stop wanting something so fundamental is a betrayal of self. Because it forms who they are, some other patients are willing to put a lot of effort into resisting the inevitable. While Dylan and I try to chomp through our meals and then run away, wringing our hands in distress, (although we’d never admit this is how we were feeling) other patients will sit stirring a bowl of soup, listlessly, for hours, making it as cold and unpalatable as possible. This is who they are and, unlike Dylan and I, they are effectively communicating their distressed personality. There is even a little rebellious pride in their stubborn resistance. They are sticking it to the man, maintaining their integrity as anorexics.
I think this is also why anorexics often get worse once diagnosed. Our behaviour has been increasingly erratic; our thinking increasingly disordered, but once we know what we are, everything falls into place. We know how we should be behaving; we take to it like a duck to water.
Middle-aged Male Anorexic 