Anorexia is full of paradoxes. Anorexics starve themselves yet feel nausea at the thought of eating, are fascinated and repulsed by watching others eat, compare themselves constantly with other people while being profoundly self-absorbed, combine apparent invincibility with obvious weakness, treat hunger as the definitive proof of control and the ultimate danger of losing it. These paradoxes aren’t inexplicable mysteries; most derive directly from the feedback loops that starvation establishes between mind and body. Nonetheless, they’re certainly arresting as psychophysiological phenomena. And one that strikes me particularly often and forcefully in messages and comments from readers is the paradoxical prevalence of the assertion of uniqueness: everyone thinks they’re the only one who doesn’t fit the mould.
The most common, and the most pernicious, context for this kind of conviction is the progression of recovery: because of such-and-such in my past or present, my future will not pan out the way it’s meant to / the way the doctors tell me it will. ‘Because I was overweight before the onset of my anorexia,’ for instance, ‘I don’t think weight gain will stop at a healthy level for me’. Or, ‘because I’ve regained so much weight so quickly despite having added hardly anything to my diet, I must be on track to get morbidly obese’. Or, ‘I was always small as a teenager, so I think my natural BMI is only about 18-19’. Or, ‘because I’m not very severely underweight, I don’t think overshoot needs to happen for me’. Or, ‘because I’ve been so ill for so long, I’ve ruined my metabolism and it’s never going to normalise’. The danger comes because this kind of reasoning tends to result in the conclusion: real recovery is too much of a risk. (In practice, either: ‘I’ll end up overweight again if I’m not careful’ or ‘I don’t need to gain much more’.) To this extent, it’s just one of anorexia’s many clever tricks to keep one trapped.
Given the kind of illness anorexia is, it isn’t surprising that issues of bodyweight and metabolism take centre stage in this habit of thought. But these concerns with metabolic normalisation or the plateauing of weight gain are just one thread of a broader fabric crucial to the phenomenology of anorexia: the illusion of individualism. One way that anorexia sustains itself psychologically in (as far as I can tell) the majority of cases is through the illusion either that anorexia (or starvation) makes one special, or that because one is special/different one has to starve oneself – or an unscrutinised combination of the two.
There’s a bit of truth to both: risk factors for anorexia include perfectionism, low self-esteem, depression, anxiety, and a history of abuse, so sufferers may be in some senses ‘different’ before they become anorexic. And from the other side too, anorexia does in a certain sense make you special: at least, it makes you abnormal. In anorexia, after all, one survives on less food than is adequate to maintain a healthy bodyweight and optimal physical functioning – in practice, on less than other people might think is possible. In anorexia, one feels hunger but doesn’t act on it except very selectively – more selectively than other people might think possible. And positive value judgements are very easily attached to both these abnormalities. Indeed, one of the trickiest things about recovery is that because the Western social norm is now overweight, thinness – even extreme thinness – has social cachet, so rejecting illness means relinquishing that too. But in a far more profound sense, of course, anorexia strips you of specialness, of difference, of individuality: it reduces you both to a pale imitation of who you used to be, and to a dreary likeness of all the other men and women who starve themselves as you do, without quite knowing why.
The moment of realising this – which, because anorexia is often characterised by high levels of self-insight, often comes quite early on – can be potent, painful, and revelatory. But, because anorexia is also usually characterised by gulf between insight and action on that insight, the revelation may, as in my case, not be enough to galvanise change. I began to grasp the agonising banality of what I was doing on the day I was first diagnosed with anorexia, aged 17, at the end of my first session with a child psychiatrist, together with my parents:
It wasn’t as bad as I’d feared. He asked lots about our family relationships, about the origins and development of the problem, about how I felt – at the worst times and now – about my weight… everything really. And he listened and seemed to care […]. One thing that stands out from this morning – when the guy said, ‘I’m in no doubt that you are suffering from anorexia nervosa.’ No one had ever said it so calmly, categorically, irrefutably. In some ways it was a relief, but it scared me that he was obviously so familiar with all the symptoms I was describing – it made them more normal and therefore took away one of my strongest weapons against them. (20 May 1999)
I felt relief because I was understood, but I also felt fear because that understanding robbed me of the illusion of uniqueness. There was no heroism in fighting all those symptoms of a starving mind and body if the fight was one that whole dreary battalions of other pitiful adolescents were fighting at the same time; there was no glory at all in being just like them. This must be one of the great powers of diagnosis in mental illness: forcing you to acknowledge that you are part of a group. How your mind is working or not working isn’t just you, but can be classified in terms of a shared and predictable set of psychophysiological features. You fall into a diagnostic category. In anorexia in particular, the jolt of coming to realise this can be quite abrupt.
That isn’t to say that for me, the diagnosis changed anything fundamentally or lastingly. I did manage to regain some weight, but only temporarily. And indeed I don’t think the realisation sank in properly till a year later, when one day I visited my psychiatrist again:
A lazy day – the one burst of activity was cycling to the hospital for my appointment with Dr S., who seemed much reassured by my weight and reports of post-dinner chocolate-eating. We had the shortest session yet – less than half an hour – and we’re to meet again in two months’ time. It’s reassuring to me too, to go there and compare my state to how I was eighteen months ago – I feel in control now, and it’s not an illusion anymore. What brought my relief home to me was the smallest thing – he opened the door to the ‘weighing room’ without knocking and there was another teenage girl in there on the scales, her doctor peering anxiously over her shoulder – and the utter ridiculousness of it all overwhelmed me: we all think we’re so new and special and important, we stupid anorexics, but we’re not, we’re among millions of women equally self-centred and short-sighted, and it’s not a clever thing to do. It doesn’t make you special. It makes you a tormented bony creature perched on a weighing scale. (21 June 2000)
Something about the visceral visuality of this moment affected me more violently than anything had before. This, I realised, was where an addiction to hunger really leads: not to any alluring airy ethereal realm beyond the bodily, but to a weighing room in which you’re just one in a long revolving cycle of emaciated girls who look like you, think like you, understand and fail to act like you. This too, predictably enough, wasn’t enough to change anything for real either. But from then on, the double vision of seeing myself from the inside and the outside, at once or in quick succession, was a permanent feature of my illness, shifting in and out of focus: now here I am, adding another gram of low-fat margarine to make it exactly 25 g, making sure it’s never one more or less, and now there she is, that strange intensely focused skeleton wrapped in dressing gown and cardigan, devoting all her energies to margarine when she could be – well, I rarely got that far. Eventually I learnt to laugh at that strange creature, and that took away some of the power of her all-consuming obsessions, but that took years more, and meanwhile I remained somewhere between being in thrall to anorexia and accepting its complete banality.
Again, of course, as with everything in human health, progress towards recovery isn’t quite as simple as acknowledging that anorexia flattens out individuality. However depleted their minds and bodies become, anorexics remain individuals, they retain some residues of the character traits, physical characteristics, acquired habits of language and thought, that defined them before them grew ill. And these variations mean that nothing can be predicted with complete confidence in illness or recovery – after all, all the statistical probabilities in the world can’t tell you how a given individual is going to act in a given context, so why would these complex processes be any different?
On a broader scale, factors like sex, race, social and educational background, and so on will clearly have effects on how anorexia takes hold and is recovered from. But the problem is that, as I’ve said, a rejection of similarity in favour of difference is part of the pathology of anorexia, such that a reasonable therapeutic strategy may be to downplay or even deny the difference in favour of the similarities, in the spirit of countering one extreme with another and hoping we’ll end up somewhere near the middle where reality lies. On the one hand, this may be deeply offputting to sufferers who are perfectly aware of some of the complexities that must determine individual responses to, say, a given treatment method. But on the other hand, foregrounding individual variation only gives fodder to the insatiable hunger for difference that contributes to the anorexic mindset. Ultimately, although the science of understanding and treating eating disorders still has a long way to go, its basis in randomisation and replication means that, just as with diseases more wholly of the body, it probably knows a whole lot more than the sufferer does about how to turn sickness into health.
In many respects, the mechanisms of illness and recovery are almost unsettlingly predictable; hence during my final course of treatment, the one that was successful, my therapist was able to draw the line on my weight chart that marked a BMI of 19 and tell me how my thinking would have changed once I reached that point, and was right, even though at the time I was just as sure that she was wrong as I was that I’d never, ever get there. And the funny thing was, whereas during earlier phases of treatment I’d never felt normal, and sometimes wanted to be (I just want to be normal, I want food not to matter any more (07.02.99)), but more often not (Maybe I’m just afraid of becoming normal. I want people to recognise that I have a problem. I’m sick of being thought of as infallible (15.03.99)), during this final recovery attempt I felt much less preoccupied with normality and difference. If anything, it was the anorexic community rather than the world of the healthy that I was determined to distinguish myself from, by proving people wrong when they made it clear they didn’t think I’d manage it this time round either. Recovery from anorexia always involves some degree of pulling oneself up by one’s bootstraps – partially achieving, or simulating, a more recovered state in order to make it possible to get there – but maybe one sign that you’re really ready for recovery is that you stop thinking of anorexia as a source of or response to individuality.
When it comes to your own body and mind and your own recovery, it’s probably safest to assume that anorexia will always be looking for ways to trick you into deferring the day when you reject it; that’s how it survives. And asserting that you constitute the sole exception to the general rule is one of its favourite ploys. Be on the lookout for it, and remember that the sense of exception only proves the rule. And above all, because you need to see this coming too, don’t let yourself think that once you understand it, this understanding in itself makes you exempt. It doesn’t. Even when you learn the rule, you’re still subject to it; there is no privileged meta-level where you get to look down at all the other suckers and say ‘I surpass this’. Of all the little lies anorexia whispers to you, this is amongst the most monumental.