This post is conceived as a sequel to my last one, and in particular as a clarification of my last sentence there. I said that "thinking of recovery as taking back control from the illness may, beyond the early stages, create problems of its own, like re-clenching that chronically tired fist—but that’s for another time." I’ll now attempt to explain what I meant.

The process of successful recovery can—simplifying things, as models always do—be split into three phases: deciding and beginning to eat more and get better; continuing to eat more and get better physically and psychologically; and allowing recovery to flow into the life beyond it. Each bears a distinct relationship to the idea of control.

Phase One: Taking back control from anorexia

The first steps involve a certain cognitive recalibration when it comes to control. This might be summarised as follows:

  • Accept that anorexia has, to a greater or lesser extent, taken control of your life and thereby made it in identifiable and substantive ways worse.
  • Accept that taking action to recover from anorexia therefore constitutes taking control back from the illness.
  • Accept that the primary—both the first and the most important—element in early recovery is to eat more.
  • Accept that eating more is therefore now what constitutes taking control.
  • Accept that eating less is therefore now what constitutes continued lack of control.
     

Acceptance here needn’t mean wholehearted belief; all it really has to mean in this early phase is that you decide, even just once and precariously, that it is true, and then act accordingly, on the foundation of that insight, even if you lose sight of it now and then (or most of the time). (This is the ‘fake it till you make it’ or ‘act as if’ principle, which has merits in many realms.) Acting accordingly means primarily eating enough, consistently enough, to regain weight. It also means refraining from vomiting, using laxatives, over-exercising, and all other behaviours whose effect is to compromise weight restoration.

The simple act of making a plan can be an incredibly powerful support here. If you have on a piece of paper in front of you the description of what you are going to eat today, and then you go on to eat what you’d written that you would, it’s much harder to construe that eating as loss of control, as failure, as deserving of panic or disgust. Those responses will probably still occur sometimes, but the plan, the small simple reminder that this is exactly what you intended, and what you believed in, in that calmer moment before you actually did the eating, can work wonders.

Give your plan as much detail as you need to make it viable for you to follow it. If you know you tend to let mealtimes drift later and later, and that the increased hunger or loss of sleep that entails are unhelpful (both in that they compromise weight gain and also in that they indulge the rejected anorexic definition of control as deferral), include the times when you’re going to prepare your food and eat it. If you find you make excuses to yourself about not having the right food in the house, note down when you’re going to buy it. Also decide what you’re going to do if you miss something planned, so you can get back on track as smoothly as possible (whether by ignoring the lapse and carrying on as if it hadn’t happened, or by making up for it later – don’t get too hung up about this, since getting obsessive about having backups for your backups will be far more counterproductive than the minor lapse itself). The plan is your guide and your permission, and its physical manifestation as something outside your own mind is crucial to its being able to fulfil both these functions. Thoughts remembered and reinterpreted can get terribly hazy; words clearly written can’t.

Phase Two: Staying in control of your recovery

This is the phase where the most acute challenges to the anorexic value system occur. The restoration of the body after starvation not only involves the ongoing act of eating more, which already runs counter to everything anorexia stands for; it also brings all the predictable corollaries and consequences of eating more: weighing more on the scales, having more bodyfat, experiencing your hunger as something to be acted on, feeling full after eating, etc. As time passes, other challenges will join the early ones: eating more than others, not being the thinnest person any more, not needing the smallest clothes, and so on. Every one of these challenges, and all the littler things that you as an individual may find particularly difficult, are both acute and chronic: they require a high degree of resolve at specific moments (standing on the scales, sitting down with a plate of food), and they require that resolve to be re-enacted time after time.

And if the bravery required to show resolve like that, over and over, is to be defined, one reasonable definition would be: managing to reject the anorexic definition of control, right now, one more time. Control is now not less and less: eating less, weighing less, taking up less space, deserving less, feeling less. Control is now more: more nourishment, more solidity, more hunger acted on, more you, taking your place in the world.

Again, the redefinition doesn’t yet need to be fully acquiesced in. If the idea that being more solid could be a good thing still makes you uneasy, prompts in you that little nervous twitch of non-acceptance, that’s OK. Again, what matters is that you have enough acceptance that you continue to perform those daily, hourly acts of brave rejection, with the body and mind that get stronger every time you do.

Learning to have faith in your past self—the one who got you started on Phase One in the first place—rather than to treat him or her like a traitor whose violations have to be condemned and then repaired, is another important thing here. For me at least, much of the anxiety interwoven with my anorexia took the form of a refusal to give my past self any credit, ever: whether I was fretting about not having locked the door, or at having offended someone, or at having left a mistake in an article, or whatever it was, I was refusing to accept that Emily of an hour or a day or week ago might have been trustworthy, have had reasons for doing what she did, have done her best, done well enough. That life shouldn’t be about repeatedly wresting back control in the wake of an idiot who had too little.

Part of this phase of recovery, which can feel long and arduous, is believing that your past self was right about some key things: that he or she had had enough of being ill, and couldn’t stand it any more, or had decided not to stand for it any more; and that he or she had, given those facts, made a worthy plan in response to them – that simple but potent meal plan which you now continue to accept, every day, every meal, until you have good evidence that you should do something different.

That past self knew that following the plan she made would cause her—you—to grow. That was the point. So finding that you are growing is not a reason to abandon the plan. She feared that the growing would happen in all the worst ways—around the tummy, on the thighs, wherever—and that it would cause her all the worst kinds of pain, bodily and mental. And she made it and started to follow it anyway. Your days of eating are now proving some of her fears right, some of them wrong, but in either case, her rationale still holds. You were right before, and you still are.

(Of course, this raises some interesting questions about how the other past self—the one in denial, the one who refused to do anything put push him- or herself to ever greater heights of self-destructive control—relates to the one you are teaching yourself to trust. People have different ways of experiencing and conceptualising their illness in relation to self: anorexia may be the evil whisper or the minx on the shoulder, or the body itself may become alien or uncanny, or illness may simply come to seem like all you are. (Fredrik Svenaeus 2013 [download the PDF here]  discusses these variations from the perspective of phenomenology.) The externalising of anorexia that’s often encouraged as part of therapy will therefore come easier to some than to others, just as will the negotiating of shifting identities. In any case, the point to hold on to is that you were not only your illness, otherwise you’d never have got even to Phase One, let alone beyond it to Two. It’s the parts of you which got you here that deserve your trust, and your gratitude.)

Phase Three: Leaving control behind

This phase is the hardest to pin down. It stretches from somewhere near the end of weight restoration to somewhere out beyond it. And I think this period of time and experience is where something critical happens, or doesn’t. As Phase Two progresses, and you carry on growing, and you grow also a little more accustomed to eating more, you may start to realise that something is changing in your attitudes to control. Your meal plan may be where you notice this first: you might find you don’t need to follow your plan to the letter any more, because less and later have stopped being your default. Maybe you know you’ll let yourself have a biscuit or two with your tea at someone else’s house, and that if you’re a bit hungrier than normal when you get back, you’ll add a bit extra for your dinner, so you don’t have to build in a formal compensation for the missed snack. You may notice it on the weighing scales too, if you’re weighing yourself: that you don’t particularly long for the numbers to be lower any more, maybe (hopefully) that you even feel some satisfaction when they’re higher as planned for and predicted. Or the change may make itself known in your response to your body in the mirror or your body in action, or in your feelings about other people or your dreams for your future. In any and all of these ways, you may start to know that you want to keep on changing, and that recovery is no longer something you are making yourself do with trepidation, constant ambivalence, and the superhuman exertion of control against the instincts of anorexia. This is where Phase Two starts, slowly and still without guarantee, to give way to Phase Three.

This new concord between what was planned for and what transpires is another significant step away from the version of control that anorexia constructs. Deciding to do something, planning how to do it, putting that plan into action, and seeing what you planned happen is a remarkably satisfying thing, in amidst all the predictable spikes of fear about the specific incarnations of your success. Ideally this confluence of cause and effect gathers momentum as a river does from its tributary streams, each new planned act of bravery making the next easier, until the plan itself, those little pieces of paper to which you once clung so perilously, becomes ever more superfluous. This isn’t to say that there’s no conflict—until physical recovery is complete, and probably for some time after that, there will be times of fear, self-loathing, revulsion, nausea, more fear. But the crucial thing about the cognitive dissonance now is that it’s dwindling rather than growing, and you’re now becoming stable enough to deal with its effects.

Of course, in a simple sense there is convergence of intention and outcome in anorexia too: you plan to eat very little, and you do; you plan to get thinner, and you do. But at the same time, during the descent into anorexia, the dissonance accompanying that harmony grows ever more extreme, like a fretful off-balance beat beneath a melodious overlay. The dissonance strengthens as the emerging value system—whose central web is spun of control—does too, all its tenets conflicting more and more forcefully with what you once knew and recognised about being healthy and unwell, being in control and out of it. In short: beyond a certain point, you know you’re ill and have ceded control to something stronger than you, but you have to pretend not to know it, reducing the discomfort of dissonance by repeating all the mantras about why not eating and being thin matter more than anything else, or by luxuriating in media panic about the perils of obesity, or by immersing yourself in words and images that deify thinness, and by a hundred other means, many of which will adopt the irreproachable guise of control. Nonetheless, the source of the dissonance persists, and only rumbles louder under the surface.

In recovery, by contrast, control stops being a cloak for its opposite, and starts living up to its name. Exerting real control brings real benefits (like being able to think more clearly, sleep more soundly, walk more steadily, breathe more deeply), and those benefits in turn make exerting control easier, and so, robbed of its blood and sinew—the supposed delights of abstinence and awfulness of self-generosity—the dissonance withers.

And somewhere along this road, something stranger still may happen too. You may come to see that exerting control is simply no longer what’s required of you. Eating may have changed from a hazardous and minutely planned affair to something you do for pleasure as much as for fuel, to something (at least most of the time) natural and calm and more flexible by the day. And your body may continue to grow, and your weight to rise, past the point where the doctor said to aim for, past the point your past self ever hoped or feared she or you would reach, past the close comparisons with some of your friends, maybe even past what the medical establishment tells you counts, for the general population, as healthy. And nonetheless you see that any exertion of what you could then or now have called control must be the wrong response.

Just as starting to ‘take control’ of your intake by restricting it again is the wrong thing to do, so ‘staying in control’ by persisting religiously with the plan you’ve outgrown is now the wrong thing too. You don’t need to try to gain weight any more than you need to try to lose it. There isn’t any plan any more. The plan is to let my body decide, and find its own equilibrium. The plan is not to carry on insisting that there’s a gap somewhere between me and my body. Prying open that gap with tweezers, then pliers, then an endless vacuum, was what got me in over my head in the first place. It doesn’t take much insight to see that the way out will not be further along the same path. How life is for me now is neither out of control nor in control; control just isn’t a relevant concept. I imagine the same is true for many people who are healthy and happy.

Sometimes control comes to mind briefly, as a possible resource when things get difficult, but that doesn’t mean it’s there lurking all the time—and I can’t say its suggestions ever seem very helpful. Control is a concept with a long and apparently impeccable history, from the colonnades of the Stoics to the ‘epidemic of obesity’, and it has quietly fed disordered eaters, as well as a whole host of other devaluers of the body, through all those centuries too. Unlike peace, youth, and money, control is not something you only realise you were dependent on once it’s evaporated. It’s something that evaporates just as soon as you stop depending on it.

I like other metaphors now. I like balance. I like strength. I like the sweep and retreat of the waves.

Of course, this isn’t the end of the road. Even once the weight gain has slowed and come to a natural stop (as it will – without you exerting control to make it), even once eating is easy and life starts to wash back in now the dam is levelled, recovery continues as you work out how to keep your footing in the less tangible realms of relationships, and achievement, and exertion, and responsibility. But then that fourth phase is maybe just called living.

You are reading

A Hunger Artist

Why Your Mistakes Matter Less Than You Think

An insurance claim and the structure of reality

Making Space for the Exceptional

Experiences of extraordinary flow.

Early Intervention as Panacea: Reality or Myth?

Questioning the evidence base for the efficacy of early intervention in anorexia