In some ways, anorexia feels like one of the most significant things that ever happened to me; in others, it feels like the ten years I was ill never really happened. Illness of all kinds changes us, in ways we can never have stable insight into: asking what kind of person I would have been otherwise is a bit like asking who I’d have been if my mother had married the man she was engaged to before she met my father. That person never existed.
One of the things that hastened the shrinking of my anorexic years into a tiny bubble of almost imaginary time were the things my family said in the later phases of my recovery (from maybe six months or so in): that it was like having the old Emily back. For them, too, it was almost as though those ten years had never been.
At the end of a radio interview my mother and I gave together two years after I started to get better, she said:
‘I think in the end, that's the oddest thing to me. We're only, what, two years on - scarcely, not even that - and yet it almost feels like to me as though - not that it didn't happen, but that it wasn't like ten whole years out of - more than a third of my daughter's life. It doesn't seem to overwhelm anything any more. Which is kind of hopeful, isn't it - I mean, hope to other people, that sort of realisation that you can have all that, and I'm not looking back with huge anger, or resentment. Sometimes I wonder why, I think - hearing Emily talk here, I've thought: yes - when she said about hurting - she said something about regretting how much hurt she'd caused to other people. It was terrible hurt; it was awful, awful pain, to lots of people. But now it's gone. And now here you are, Emily, my daughter [laughs] - yes I've got my daughter back. But you know, new daughter every day, and life's moving on, instead of just being stuck, like it was.'
It’s as though her daughter, the Emily they had known as a teenager, had been waiting in the wings, sidelined but not forgotten, needing only the alchemy that turns custard tarts into more of a human being to step confidently back on to the stage and reclaim her role from the understudy who’d been pretending.
Let me run with that metaphor a while.
That understudy had no clue what she was doing. She managed traces of Emily, but so cloaked in impatience, in arrogance, in insecurity, in the cold and frightening air of someone who never partakes, in miserliness and unreasonableness, that barely anything else ever came through. On the other hand, the understudy knew exactly what she was doing. She let all the darkness of those traits creep so stealthily into her performance that Emily, watching from the wings, never saw it happening, never saw the moment when it turned from being an acceptable performance of her to being a travesty. Like watching an insincere smile start to fade as soon as its target has turned away, the precise moment at which apparent warmth gives way to frightening cold could never be pinpointed. Emily came to believe that this was who she was.
The theatre analogy is in some ways apt and potent. It gets us away from thinking about personality as a mysterious inner quality, and makes it performative: constituted by the ongoing acts by which we engage with others. I imagine a whole world of theatres, many showing varied and fascinating performances by the people born for acting, and some with understudies as unpleasant and unconvincing as Emily’s, but getting away with it, because of some clever little sleight of hand by which they disguise the switch.
I imagine, too, that glorious evening when a slow anger starts to build in the audience, and their calls for the understudy to leave the stage grow in pitch and volume, and she can no longer resist the force of their fury, because she has always known the hollowness of her rendition, and has no strength left once her bluff has been called, and sinks to her knees and whispers something that just might be an apology, and Emily, or Emma, or Eleanor, who can barely walk from sitting so long watching, and who barely remembers how she used to play the role, peeps out from the curtain and feels the heat of the lights on her cheeks, and crawls out to where the understudy is curled shivering, and whispers something in her ear which might be forgiveness, and steadies herself on the understudy’s shoulder to come up to standing, and turns out into the dark of the auditorium, and feels the growing murmur of their gladness lift her into speech.
The metaphor misleads us, of course, in other ways. Emily and her understudy were never separate; it only sometimes felt that way to their audience, who felt they’d been robbed of the person they knew and loved. In fact there was only ever one actor, and she simply lost sight of the role she was playing.
But if we accept the analogy, with its limitations, it can help us understand certain things. Not least, the fact that all those theatres peopled by unconvincing understudies are dispiriting most of all because they’re all the same. The obsessive, prickly, stingy, tired, judgemental person I turned into during my anorexic years was very similar to the obsessive, prickly, stingy, tired, judgemental person that anorexia turns most people into. The things that do differ between people are the few lines that the understudy hasn’t quite managed to make a total hash of.
Saying that anorexia turns everyone into a horrible person is, of course, both true and untrue. One weak caveat is that it turns people into slightly different kinds of horrible. A 2001 study by Westen and Harnden-Fischer identified three personality-based subtypes of anorexia: overcontrolled (rigid, depressed, lacking in direction), undercontrolled (impulsive, emotional, angry or violent towards themselves or others), and perfectionist or ‘high-functioning’ (self-criticism plus depression but also more healthy traits than the other two categories). The ED Bites blogger Carrie Arnold gives a helpful round-up of their findings, including how the three personality clusters correlate with short-term treatment outcomes. Arnold concludes on the question of ‘whether the personality traits are driving the ED behaviors, or whether the ED behaviors in which you are engaging can also impact your personality traits. Whereas many personality traits are lifelong, many are much more malleable, and it’s not impossible to think that there can be variance over time, especially as your ED behaviors change.’
This is the second, stronger caveat: anorexia is well known to be associated with traits like perfectionism and with rigid or obsessive-compulsive thoughts and behaviours (e.g. Phillipou et al. 2015), but it’s not always easy to tell how much those traits were in fact part of the predisposition to anorexia. With any question like this, the chickens and the eggs are hard to tell apart. As Philippou and colleagues point out, longitudinal studies – ideally starting before illness and continuing long after recovery – are needed to determine how particular personality traits predate, coincide with, and/or outlive the period of clinical diagnosis.
The third qualification is that it might not be anorexia per se that effects the transformation: simple starvation might be enough, as testified to by the dramatic personality shifts manifested in the Minnesota Starvation Study volunteers, who became apathetic and depressed, nervous and hysterical, withdrawn and irritable, narrowly focused, bad at concentrating, oversensitive to noise, uninterested in sex, and all the other things one recognises in one’s anorexic self (Keys et al. 1950; see also my first post on the experiment). As Ancel Keys and his colleagues put it, ‘Hunger pangs, coldness, weakness, and lack of endurance cannot be constantly experienced without producing a set of mind and a direction of attitude’ (p. 905). And the volunteers who manifested these profoundly changed mindsets and attitudes were robustly healthy young men in whom nothing was lacking except food itself.
If it is mainly starvation itself that’s responsible for these wide-ranging changes in personality, that bodes very well for the recovery of a happier personality afterwards. Keys and his colleagues noted that not everything goes back to normal at the same speed; amongst the Minnesota volunteers, ‘The feeling of well-being, range of interests, emotional stability, and sociability were regained more rapidly than strength, endurance, normal eating habits, and sexual drive’ (pp. 906-7). But insofar as the changes in your personality are consistent with those observed in straightforward physical semi-starvation, you can be confident that they will be reversed with weight restoration.
The idea that it’s starvation, not anorexia, that changed me into someone else is the one that fits best with my experience. As soon as the physical regeneration was well under way, everything else began to shift and be less rigid. That felt magical, not least when it came to traits that seemed to have nothing to do with food or my body, like spending money.
For most of the years of my illness I kept a detailed record in the back of my diary of everything I spent, and I’d feel satisfaction whenever I found a reduced loaf of bread that meant I could write down ‘21 p’ instead of 37, and I’d tot it all up at the end of every term and be happier when the total was smaller than last time. The miserliness wasn’t totally indiscriminate: I was better at spending money on other people than on myself, and better at spending it on clothes for myself than on food, for example. But less was always better.
Though being unwilling to spend money on frivolities like holidays or novels seems to have little obviously to do with anorexia, it quickly becomes clear that there are close bonds between this kind of self-restrictive counting and the kinds that relate more directly to diet or exercise or bodyweight. And they take hold more subtly, because you don’t recognise them as pathological, and because they bear similarities to generally positive habits like being financially responsible. But they come to dominate your life no less effectively than daily weighing or calorie restriction. In concert, they all act as a vastly powerful brake on the energies and imagination that might otherwise prevail. Every potential excursion outside the routine – every drink you could go out for, every film or gig you might give a try, every invitation you might accept or spontaneous gesture of generosity that might occur to you – has a deadening press of inertia to overcome (but think how much that’ll cost you) if it’s to be realised in action.
The financial case makes clear just how much this kind of personality shift is a punishment of oneself as much as of others. As the most easily quantifiable absence of generosity, stinginess is an unattractive quality in anyone; it inserts little pockets of resentment into relationships that could otherwise be relaxed and trusting. But it also chips away at the happiness of the person who resists spending their money, because the saving of money becomes an end in its own right, constantly pitted against the pleasures that less hesitant spending can bring. In anorexia the first pleasure to be sacrificed on this particular altar might well be eating: I used to get so paralysed by all the instantaneous calculations about how much a cappuccino cost compared to a week’s ration of sliced white bread, or how many months I could live for the price of a restaurant meal, that even when it came to the most momentous evening of my life, the one when I decided to eat more again, I made the decision to choose to change my life, but could not bring myself to buy the new food I would need for my first breakfast and teatime snack the next day. Thankfully, a friend was with me who was good enough to buy it for me. On its own that pathological avarice couldn’t have killed me, but it gave just that little bit more potency to the things that could.
You can say something similar about all the qualities that anorexia amplifies. For every moment of judgement or impatience with someone else, there are ten with yourself; for all the emotional coldness that hurts and alienates others, there’s the infinite lack of gentle warmth towards you yourself. The person who takes no time for other people also gives none to him- or herself; the lashings out of irritability or anger are directed at you as often as out into the world.
Nonetheless, when we group the many unattractive habits of anorexia under the broad heading of selfishness, this two-way model suddenly seems hard to sustain. And the repeated accusation of selfishness is one of the things that still hurts the most, after all this time.
In my autobiographical musings on the course of my anorexia, quoting from my diary, I reflected on the trials of Easter eggs: to eat or not to eat? And if not to eat, to give away or not?
I ate about a third or a half of an Easter egg today – I had to – it was the one she gave me – she’d have been insulted. I can just feel it becoming fat in my stomach (14.04.98). I had to became I couldn’t, compulsion internal not social. The fear of fat would outweigh the fear of insulting; most simply, self would outweigh others. The selfishness, the self-obsession of all this cannot be over-emphasised. However much I hate hurting other people by it I am not strong enough to change it and stop them hurting. The selfishness is just weakness. Unglamorous, inexcusable.
And its companion is isolation. Obsession turns kindness into cruelty – what is it this year – why does everyone seem to be part of a conspiracy to make me fat? (16.04.98); one’s own giving turns into a desperate strategy to annul having received, the selfish opposite of ordinary selfishness, and other people’s giving turns into proof of jealousy, the selfish desire to lower to their level. Sense evaporates from social interactions and with it their pleasure.
Anorexia and I turned selfishness on its head repeatedly, but still there it was, haunting me.
My father screamed at me once, in the early days of my illness, that I was a selfish bitch, that he wouldn’t let me kill myself, and that he would force me to eat if I carried on trying. He and others very close to me accused me of being selfishly manipulative. I accused myself of selfishness. When I frightened my parents into thinking I was going to die, and my mother and I cried while I ate a small piece of chocolate late at night in our hotel room, it made me realise, more than anything, the selfishness of it all. I accused other people of it too, though – like my brother, the year I lived with him at university, for daring to try to have a social life despite my deathly presence. I recognised even then that this was just competing selfishnesses, ‘the selfishness of imposition against that of inflexibility’. But still I felt the satisfyingly righteous fury of the person who calls another person selfish.
The trouble with selfishness, of course, is that it’s a basic human characteristic. Drill down far enough into the evolutionary dynamics of social behavior and it’s what altruism can invariably be redescribed as, should we choose to. Struggles that some, especially when anorexic, might like to paint as desire versus some nobler quality like willpower, are really just desires pitted against desires: the desire to feel well fed versus the desire to feel morally good or superior or calm or in control through hunger. It’s desires all the way down.
So, to come back to the problem of whether we can really say that selfishness does two-way damage: isn’t being selfish by definition putting yourself before other people? How could that fit the idea that these traits harm you as much as others?
Well, in the anorexic context the answer is easy: it’s the illness, not ‘you’, that reaps the benefits of the selfishness. When ‘you’ lash out at your family for not understanding or accommodating something about ‘your’ needs that they could never reasonably have been expected to understand; when you don’t deign to touch the Easter egg they chose carefully in the hope that it might appeal to you, does it make you happier? No, it makes anorexia stronger. So in fact the selfishness of anorexia is yet one more form of self-punishment. Of course, being unremittingly self-punishing is also a great way of punishing those around you, but the point is that no one wins, except the understudy. When, during your illness or after you get out of it, you feel guilty for all the harm ‘you’ inflicted, remember that you (the you crouching in the wings, watching) never profited from it.
All this doesn’t mean that there’s nothing to be done, or that it’s fine to be persistently unpleasant right up until you get better. To pursue the theatre analogy, it’s good to interfere with your understudy as often as possible, altering her lines a little as she speaks them, infiltrating her mind as and when you can with whispers of greater gentleness. You might not have the strength to make your voice reach right out to where others can hear it, but it will reach as far as the stage, and because she has so little inventiveness, she might even be grateful for some of the ideas you send her way.
What is selfishness anyway? Or kindness, or impulsiveness? It’s easy to find ourselves believing in a border between actions and words and thoughts and moods and emotions on the one hand, and my actual personality on the other. The former are contingent, coming and going in the wind; the latter is the solid bedrock beneath. But personality is just what we call the accumulated sum of all the rest. In anorexia you get trapped in doing and saying and thinking and feeling a whole host of things you never used to, and that turns you into a different person. Likewise, recovery can turn you into another person again. Not really into the person you were before – after all, in all her months or years of waiting she has grown too. But into someone freed of the vast physical and psychological stress of starvation.
One of the many common cognitive biases that we all tend to manifest is the habit of saying, when someone else does something unkind, ‘she’s so selfish, isn’t she’, and when we ourselves do something unkind, saying, ‘it was such a tough situation, I ended up behaving a bit selfishly’. In what’s known as the attribution effect, we (especially those of us who grew up in highly individualistic societies) attribute more weight to circumstance when assessing our own questionable motivations and actions, and more to personality when it comes to others’. In other words, we get more easily seduced by the fiction of stable personality as a dictator of action where other people are concerned. This habit joins forces with another common cognitive error: the one that separates off mind from body and so reacts with disbelief to the sheer scale of the psychological changes that starvation can wreak. Together the two help explain why other people find the change in the anorexic person (the loss of the old Emily) so hard to grasp as anything other than a mysterious emergence of someone who is inexplicably cold and selfish and frightening, rather than as someone labouring quite comprehensibly under the great weight of a collapsing physical system.
Other people’s comments can help: they can bring back into view for a moment the reality that you didn’t use to be like this, and so that perhaps you needn’t be forever. But they can make you feel even more trapped: everyone hates me now, even those who love me; no one understands, not even those who try really hard to. It’s easy to take on those concretising understandings of others, and easy to feel alienated enough from yourself that, as back in that theatre, you no longer feel the agent of your actions, you see yourself as someone else, and you impose those evaluative shortcuts on your own behaviours. And then you come to believe that you don’t even deserve to get better, let alone have the first clue about how to go about it.
The magically simple essence of getting better is eating more. I’ve talked plenty about this in other posts (like this one), so I won’t talk through the logic or the pragmatics of this again now. But assuming that you do embark on a consistent routine of nourishing yourself back to physical health, what happens to the anorexic personality? What does the replacement of understudy with Emily look like in practice?
One thing to be prepared for is that the attribution effect extends from illness into recovery, creating a time lag when other people don’t adjust fast enough to your change in personality, and keep on expecting you to be the ill person you were, long after you feel ready to be someone else. Some people may be helpful in encouraging you to separate yourself from the anorexia (as in the 'tough love' that people said my mother showed), but may still struggle to believe in the reality of anorexia being over, and continue to treat you as though you were still ill. It’s hard to remind yourself that this makes perfect sense, and is not meant viciously, but it’s important to do so, and to find effective ways of reminding people that you are no longer the person you were.
Another thing to remember, as a source of caution as well as reassurance, is that the process of constructing a new character for yourself after anorexia is not a maiden voyage out into infinitely new territories. There are soft limits to what you get to decide about who you will be. Genetics and the environment have already moulded your default modes: the things you’ll revert to when active effort is less. There is no blank slate you need feverishly to fill with the script of your post-anorexic character. Everything – the momentary action and all its graded boundaries with what we call personality – has blurry edges, fading between past and future, between chosen and predetermined, and that’s OK.
Recovery is, amongst all the other things it is too, a process of working out which things about yourself are more the remnants of illness, which are more part of you, and which you want to make the effort to resist or enhance. That doesn’t mean that all of ‘you’ is admirable, nor perhaps even that all of anorexia is totally despicable (though I struggle to think of any sense in which it made me more agreeable). But it means that you, with all your rich mixtures of generous and loving and quirky and annoying habits, can be more than the drabness to which anorexia largely reduces you.
You may find that most of the more expansive qualities you remember in your pre-anorexic self and like in others fall fairly naturally back into place as you regain the strength and flexibility that adequate nourishment brings. You may also find that in some cases you need to retrain yourself in good habits of character just as you do in the more pragmatic ones of eating regularly or exercising constructively. You may need to actively relearn how to be kind and patient and open and welcoming to others, just as you relearn how not give into all the self-hatred interwoven with damaging behaviour that you are also relinquishing. Maybe you’ll make a pact with yourself to pay a stranger a compliment once a week, or to make time every day to perform some small caring gesture for someone you love. Practice makes – not perfect, but easy.
Maybe you’ll also find that you have to start actively rejecting the part of you that makes anorexia central to who you are. With extended illness there’s a natural tendency, stronger in some people than others, to come to think of the illness as not merely the framework for your whole identity, but also the most interesting thing about you. It can become the thing you want everyone to know about, the thing that gives your life meaning and shape and makes you worth talking to. But actually, unless they have the same illness themselves, people usually aren’t interested in your illness (illnesses in themselves aren’t interesting things unless you have them); they’re interested in you despite or including your illness.
Anorexia will always be a part of you, in the sense that it is part of your past. But once you get to the point of being able to say ‘it is part of my past’, you are certainly no longer the person it made you think you were. And that, as my whole family will attest, is an extremely good thing. Anorexia made me incontrovertibly into a less nice person than I had been before, and have become again since. In my anorexic days I was haunted by the smiling spectre of the teenager my father told me I had been: sorted, self-sufficient. ‘I wish I felt more capable – more sorted, as everyone used to think me – more capable of living in even the most basic sense, more desirous of more of life’ (25.02.03). ‘Sorted’ was the glowing but tiring watchword I’d use to reproach myself and others. I didn’t want to have to live up to it, but wanted so terribly to be able to.
What I’ve become since recovery is not what I’d ever describe as sorted. But I’m someone wiser and I hope kinder as a result of those years watching the monotonously unpleasant performance of someone who only looked vaguely like me. And I have, as my mother said six years ago, reclaimed the ability to be ‘a new daughter every day’, to be a thousand different solid complicated daughters instead of one wraith-daughter.
It’s easy to reject the basic premise of the theatre: that she is not you. You look, but you simply can’t find the you who waits in the folds of the curtain. Indeed, she does not exist. But then, nor does your understudy. There are many reasons why we like to believe in the existence of a consistently surviving self, but in fact the roles we create for ourselves are all there is. The script keeps changing, the audience may come and go, and who knows where or when the curtain will fall.
But that can be wonderfully liberating. If this scene and this act go against everything you care about, you need only begin a new one. You may need to bludgeon your unsuspecting understudy to death to do it; you may find ways of bidding her part of you farewell with less overt violence. But the future is waiting for you once she leaves it.