I stared at my plate of fish sticks, tater tots, and cold green peas. After a two hour-long staring contest, I knew every ridge of minced fried fish and every contour of pea almost by heart. Despite my protestations that I could not, would not, eat this fish (not in a house, not with a mouse, I will not eat it, Sam I am!), the tray remained in front of me. In order to leave the table, I had to eat.
It was the second day of my third hospitalization for anorexia, and I had only picked at the food on my trays until then. No stupid doctors or padded rooms or threats of nasogastric tubes were going to get me to eat. No siree.
My psychiatrist had been treating eating disorders for more than 20 years by the time he met me, and I'm fairly certain he had encountered my type before: stubborn, angry, and utterly terrified of eating. He didn't shame me and tell me how much I was hurting my parents or how much the hospital stay was costing. He didn't mention my weakening vital signs or ask why someone with so much potential would throw away her life. He simply instituted a strategy known as tray sitting.
Tray sitting meant the following: at mealtimes, you sit in front of your tray until every bite of food is gone. That means no visitors, no bathroom breaks, nothing. Just you, your chair, and your tray. When my doctor told me that he had put me on tray sitting, I almost laughed. Surely they were joking. They weren't.
When I was called down to the dining room for dinner, I brought a book to read. If I was going to have to sit here all night, I figured, then I may as well not be bored. A tech pulled up a chair and sat down beside me. I pulled out my book and started to read. I hadn't made it past the first paragraph when the tech neatly plucked the book out of my hands. I gaped. The tech looked almost amused. I hurled invective at him-how dare he take away my reading material? Would he want to eat this crap? Hadn't he heard of something called obesity?!? I was not eating, and that was that.
He raised an eyebrow and calmly drawled, "Honey, I got all night. I don't mind sitting here. I don't get to sit down much on the job, and this is a nice break. So take as long as you want. I have plenty of crossword puzzles to catch up on."
"You can't stay here all night," I told him. "Eventually, you'll have to go home and I can have my book back."
"There's a night shift that is probably as eager to sit here as I am," he replied. "You'll get your book back as soon as you finish your dinner."
Which is when the staring contest started. As I stared down my long-cold dinner, I snuck furtive looks at the tech sitting beside me. He seemed totally unbothered by his task. He finished one crossword puzzle, then another. Visiting hours were soon, and if I wanted to see my parents, I had to finish my dinner. I truly didn't have an out. If I didn't eat what was on my tray, I knew my doctor would order a nasogastric tube. If I refused that, he would get a court order to have one placed. So ever reluctantly, I picked up my fork and started eating.
My recovery didn't stay on some sort of magical trajectory after the Curious Incident of the Fish Sticks in the Nighttime. I relapsed hard, again and again. I entered other treatment facilities that made eating and weight gain much more optional. Choosing to eat would be empowering, I was told. I needed to work on the issues first. Then I would eat. I needed prayers and magic ponies to help work through the resistance. The fact that many of these theories had no evidence to support their use didn't stop some of the best-known eating disorder treatment facilities in the United States from using them.
Eventually, I burned through all of my money and a large chunk of my parents' in a desperate attempt to figure out how to choose to overcome my eating disorder. A new therapist I started seeing after the longest and most expensive of treatment stays used the same tactic as my psychiatrist did so many years ago. Eating wasn't optional. If I wanted to live at home (broke and jobless, as much as I hated being nearly 30 and still living with my parents, I realized it was still better than living in a box on the street corner), and if I wanted to continue seeing my therapist (who I adored), then I needed to eat. I wasn't given a choice. My back against the wall, and having officially run out of options, I gave in and started eating.
For a disorder that is supposedly "about control," it seems almost counter-intuitive that having no say in one's food intake, exercise habits, and about a bazillion other little daily things would be so successful. Orders to recover didn't work. Cajoling didn't work. Bribery didn't work. Eliminating every option but recovery, however, did work. Reading a recent study in the journal Psychological Science made me realize why.
Two groups of students read a mock news article about how lowering speed limits in their town would make everyone safer. One group read that the new laws were definitely going into effect, whereas the other group read that it was likely the laws would go into effect, but there was a small chance the government would overturn the suggestion. Neither group especially liked the new restrictions, but the first group had significantly more support for the new law than the second group. Our brains have very contradictory responses to rules, the researchers concluded. We do our best to get around rules we don't like, devising elaborate plans and equally elaborate excuses to get away with it. Once we realize there's no way out, however, we do our best to try and live with it (Laurin, Kay, & Fitzsimmons, 2012).
It's why the ability not to eat was always enough for me to evade recovery. In a press release from the Association for Psychological Science (publishers of Psychological Science), lead author Kristin Laurin compared the findings to why playing hard to get can be so effective in romantic relationships. "If this person is telling me no, but I perceive that as not totally absolute, if I still think I have a shot, that's just going to strengthen my desire and my feeling, that's going to make me think I need to fight to win the person over," she says. "If instead I believe no, I definitely don't have a shot with this person, then I might rationalize it and decide that I don't like them that much anyway" (Menon, 2011, n.p.).
A person with an eating disorder might rationalize eating and weight gain, then, as it being forced upon them by parents and doctors. It makes the anxiety bearable because there really is no way out. My therapist calls this "choice amongst lack of alternatives." Eat at home, eat in the hospital, or eat at a treatment center. Not eating is not a choice.
Laurin, K., Kay, A., & Fitzsimons, G. (2012). Reactance Versus Rationalization: Divergent Responses to Policies That Constrain Freedom. Psychological Science. doi: 10.1177/0956797611429468