Dr Allan Ropper, in his Reaching Down the Rabbit Hole, remembers how dismissive medical students used to be about neurology. “They called it a masturbatory speciality. You couldn’t do much of anything in the way of cure or even prevention, so you just sent patients back out on the street (“treat-‘em-and-street-‘em,” is how they put it)” (Atlantic books, 2015, p.136) Just imagine what they thought of Eating Disorders hospitals and their therapy programmes! These must appear as classic treat-‘em-and-street-‘em institutions because I suspect the relapse rates are high. No matter how much you scour your brain out, some little scraps of odd behaviour, some tics, cling on, somewhere, like cancer cells, ready to flourish as soon as you become less vigilant.
Hopefully, though, your time inside is part of a longer process that ends in recovery. Therapy’s relentless focus on the self does seem to bear fruit. You at least become more aware of how your head functions, and the exercise of thinking about your thinking isn’t at odds with rationalist, scientific principles, is it? You are simply approaching your actions, your thought processes, and your emotions more objectively and thoughtfully. You’re dealing with some very muddy, unclear areas of cognition, after all.
Over time, you begin to accept that you can be the subject under discussion, and that’s ok. You need to be prepared to dissect yourself in a workmanlike fashion without squirming.
The embarrassment itself is interesting. I think, when I was young, most people assumed that self-awareness was self-obsession, that therapy was quackery and that to take an interest in your own mental health was weak and selfish. Self-control was much admired, at least in my family, and its breakdown was to be feared. You were supposed to pick your way through life, arms at the ready, expecting to be ambushed at any moment.
Perhaps our scepticism is the condition defending itself, but I’m not sure how I feel about endowing it with voluntary power instinct. To see us as struggling with demons that possess us helps to explain our illogical, self-contradictory, and self-defeating behaviour. Our chronic indecisiveness and duality of mind, the way I can be afflicted by the blackest despair when my blood-sugar is low, yet terrified if I’m not visited by that Black Dog because it implies I’ve eaten “too much”, all this makes much more sense if each strand is attributable to one of two separate people, the demon and “the real me”.
But we are trying to dodge responsibility for our own sins: all the bad stuff comes from the horrible creature; only the good stuff is genuine. Is this part of a larger abdication that characterises eating disorders. Isn’t all anorexia a refusal to engage? Because, in fact, we chose this. And there are reasons why.
And I’m probably reluctant to admit that I’ve mishandled my whole cognitive realm, for the half a century of my existence, up to this point. Which is disappointing. I could have got so much more done! And now there are so many elements that have gone into the soup of my interior life that it’ll take ages to trace each ingredient. It’s a complicated recipe.
But Illuminating moments occur. They are usually ideas that are bloody obvious to everyone else, and that you used to be aware of yourself. What’s new, or what’s been rediscovered, isn’t the thought itself, it’s the sense of conviction – a sort of profundity of feeling that you’d lost, as if the solidity and significance of things doesn’t reside in the things themselves, but is generated by the brain. Perhaps we have “importance neurons” that cease to function when the brain begins to starve.
At first it’s exciting to rediscover something about yourself, but very soon the revelation comes to seem so blindingly obvious that you’re astonished you were ever ignorant of it. Or had made yourself ignorant of it.