What Are Friends For?Reward Contamination and Cognitive Imperialism

Dylan’s fear of solitude extended to trips out. At first, patients at Ascot House were confined to the building, where their eating behaviours could always be monitored. Even stepping into the garden was an earned privilege. Lock-down has taught everyone a little of what this feels like, but I assume you don’t have your trips to the loo monitored and logged. We yearned for release.

Other rewards were, progressively, “stair access”; accompanied trips to the nearby Tesco Express[1] or to the park; unaccompanied trips to the same places; trips into town in the company of a care worker, and, finally, unaccompanied, trips into town.[2] These helped to give us a sense of progress and achievement. Without them we’d have despaired, lost the doldrums of our repetitive days.

Dylan, however, was reluctant to exercise these privileges. He’d say he was going to the shops, but just wouldn’t get around to it, which is bizarre, given that we had nothing else to do. It wasn’t that he’d become institutionalised, exactly. It was that he didn’t like to be on his own. He went into town once and returned looking frazzled. He’d felt overwhelmed by people, yet profoundly lonely. This was to be my experience, in my turn, but, while I hated the first of these two sensations, I loved the second, in a self-pitying sort of way.

What Dylan needed was a companion, but, like all anorexics, he’d lost contact with his friends. For me, friends and friendships are incredibly important and I remain ardently loyal to their memories. But these memories are the relics of a lost golden age, worn smooth and indistinct by years of constant handling. I know that everyone has moved on and changed, has new concerns, experiences, friends. They are not who they were. I know I’m too caught up with the past, that these friendships are too important to me. If we meet, I’m the oddball, the overly intense little scrap of a creature from their past: overly familiar, tedious. They tolerate me out of the goodness of their hearts, because they are lovely, but they’re embarrassed, relieved when I leave.

I know this, so meeting or talking to them fills me with confusion, anxiety, humiliation, inferiority, guilt[3]. I flee from the idea with alarm, so I betray and neglect them, ironically[4], never getting around to contacting them, never having the nerve to arrange to meet. Presumably they think I’m a neglectful, uncaring little sod and this makes me sad, but is easier to deal with than the truth, which is that I love them too much to ever talk to them again.

Perhaps from this has grown a feeling of intense mortification whenever I access any long-term memory at all. I try to avoid remembering things; I try to keep moving forward through a fleeting series of impressionist presents, shaking off and abandoning each successive past as it develops, with a shiver of revulsion. I am told that emotional content makes something memorable. We remember events which contain heightened emotions, so perhaps it is this quality of the past that I am over-sensitive to. My brain is malfunctioning in its perception and processing of emotion.

But the past remains precious to me, so the anguish I feel when confronted with it seems to becomes almost like the homage paid to it, and this confused ambivalence bleeds into the general carnival of distress that makes up my anorexic identity. I don’t want to relinquish it.

Carrie Arnold devotes a section in Decoding Anorexia (2013, Hove: Routledge) to “reward contamination” the idea that the brain can confuse reward and punishment signals, because both are processed by the same dopamine-rich part of the brain, using “the same neural mechanisms” (p124). Ms. Arnold is talking about punishing exercise regimes, but I feel this could explain why abject mortification and distress should almost be something worth seeking; how it seems worthwhile, valuable, dramatic, significant.

Anyway, perhaps Dylan shared this attitude to friendship. And all this fuss in the head that we both seem to experience: could it be ADHD?

Or perhaps not. I know, it’s deeply presumptuous of me. It’s a form of Cognitive Imperialism to try and colonise another person’s head with my thoughts. I’m sorry.

  • Footnotes:

[1] We’d wander around the aisles with interest but never buy anything, obviously: it was mainly food.

[2] We also had the ominous “Snack out”, first accompanied and then, finally, unaccompanied, but this was never a privilege. Not to a bunch of anorexics…

[3] This feels very similar to a Pavlovian sense of mortification, I developed any time I had a hangover, as a student, because I’d always made a fool of myself the night before. When I’d calmed down a little, in my mid-twenties, I still felt incredibly embarrassed any time I had a headache.

[4] “Ironically” is a word I’m using a lot when discussing anorexia. I guess it fits with the confusion and double-vision that the condition causes, all the double standards, hypocrisy, self-defeating behaviours, self-contradiction, holding, and acknowledging, two contrary positons simultaneously;  truly believing that a behaviour is bad for us and genuinely desiring not to do it, but then doing it anyway…

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