Consuming Fictions: Reading and Eating Disorders

Research findings and personal perspectives on ‘bibliotherapy’

Posted Sep 30, 2018

How much of your day, and your week, do you spend reading? What kinds of things do you read? Has that, or the amount, changed over the years? Does what you read ever feel relevant to your mental health, in intangible or perhaps distinctly concrete ways?

This post is a reflection on these questions, both from a personal perspective and, interwoven with it, from the perspective of research I’ve carried out over the past four years. 

Ways of reading

I studied literature throughout the decade of my anorexia, and it never felt very relevant to either my illness or any of my recovery attempts. I mean, the studying did: academic work was the fabric of my life, and my best pretence at a purpose to it all [link to academic charade post??]. But the literature itself didn’t: it was, increasingly, nothing more than the object of the work. I pretended (including to myself) to love it, but really it didn’t touch me. It got nowhere near me. That was helped by the fact that I read French and German for my first degree, so everything I read was in other languages – languages I was getting increasingly fluent in, but still, without the emotional immediacy of English. And my Masters and doctorate were just German, and although the subject of my PhD, Franz Kafka, was the author I thought I loved most, it was a distanced, diffuse, intellectual kind of love – or like something more ardent but with a wet blanket thrown over it.

To an extent, that’s the only way anyone can love Kafka: his protagonists tend to be unfleshed-out vaguely unpleasant everymen often referred to only by single initials, his plots veer between minimal and tortuous and incomplete, his scene-setting is often nearly non-existent. In the end, all this became the subject of my doctoral work: asking why, in spite or because of all this ought-to-be-offputting weirdness, his writing is so powerful; why people keep reading it. Having proposed, and got funding, for an altogether more conventional project, my DPhil (PhD) became as much about bringing the science and philosophy of vision and mental imagery into the study of literature as it was about adding to the already towering sum of Kafka scholarship. And my questions and answers centred, in the end, on the question of what it is that makes the ‘Kafkaesque’ simultaneously compelling and unsettling: what makes it able to draw us in but also repel us, how it make us fascinated but alienated. Yet all that time, reading and rereading and analysing Kafka’s novels and stories and letters and notebooks, and trawling through the secondary literature and the scientific papers, and even conducting an experiment to explore other people’s responses to one of his stories – I was, looking back, kind of faking it. Yes, I felt something akin to unsettled, and maybe sometimes something approaching compelled. But they were shadows of feelings. 

I was struck by this recently, reading in English translation a book I’d read in German and written an extended essay paper on as an undergrad: Hermann Hesse’s 1929 novel Steppenwolf, which begins with a man who feels half man half wolf, alienated from the world, and on the verge of killing himself. Back then it was a dense difficult text full of symbolisms to be unpacked, tropes to be tracked, and structures to be dissected. Reading it last month, it was moving and intense and made me ask questions about my own life and sense of self, and about the lives and selves of other people close to me, at every turn. Of course, there are four huge differences: 20 versus 36, anorexic versus well, German versus English, reading for fun instead of studying. That quartet would make anything read differently. Similarly, Kafka makes me laugh more easily in English. But then, I laugh more easily now than back then. And cry: like at Kafka’s grave in the Jewish cemetery in Prague, three years ago.

The origins of my work on ‘bibliotherapy’

A few years after I’d got fully better, I returned to Kafka’s 1922 story ‘A Hunger Artist’, and was struck by the absence of any description of hunger in a man who fasts for a living – and struck, just as much, by the fact that it had never once struck me all the times I’d read the story before. I’ve said more about that, including the journal article that observation eventually gave rise to, in my post about the title of this blog. But I haven’t yet written on this blog about the research project that arose in turn from that article and from my questions about reading and hunger and noticing or not noticing. 

In the academic world, the competition for research funding is growing more and more intense, and the requirement to demonstrate the value of that research is growing all the time too. Demanding relevance, usefulness, ‘impact’, is obviously a bad thing if it’s demanded of everyone, all the time: it cripples blue-skies speculative long-term research, it puts far too much power in the hands of the people who get to define what impact means, and it tends to devalue kinds of impact that are hard to pin down relative to those that are easy (like making money). But in the humanities in particular, what has become known in the UK as the ‘impact agenda’ has also been a helpful prod to ask ourselves why we do what we do, and whether being useful need always be a definitively bad thing. 

For me, the creation of a series of Knowledge Exchange Fellowships at The Oxford Research Centre in the Humanities (TORCH) in 2014 was the form the prod took. Knowledge exchange is the idea that academic activity should involve a two-way flow of both knowledge and the benefits of knowledge, between the academic institution and some part of the rest of the world. I was musing on questions about my personal history and how it affected my reading habits, and it occurred to me that there’s also the converse question: not just whether my anorexia had changed how I read, but whether how I read might have affected my anorexia. And whether reading might affect other people’s health and illness, and their health and illness affect their ways of reading.

So, I got in touch with the UK’s leading eating disorders charity, Beat, and their Research Officer was keen to collaborate. I worked out that although some theoretical and empirical work exists on bibliotherapy, or the therapeutic use of reading, it’s very limited across the board. For the field of eating disorders, there is a growing (and promising) body of work on self-help bibliotherapy (reading self-help books with or without structured guidance), and lots on the largely negative effects of mass-media body ideals, but nothing on ‘creative bibliotherapy’ (the reading of fiction, poetry, etc.). So we hatched a plan for the six-month fellowship: to conduct an online survey asking people about any connections they might perceive between their reading habits and their mental health, with a focus on eating disorders. We had a phenomenal response, with nearly 900 people completing a survey that wasn’t at all short or simple. Perhaps you were one of them – in which case, thank you again. The time you gave to answering our many questions, and often to writing a lot of detail in elaboration on your answers, helped create a dataset that was rich beyond my imaginings. It’s now given rise to two book chapters and two journal articles, and I still feel I’ve only begun to scratch the surface of what’s there. 

If you didn’t get a chance to take the survey, but feel like you have any thoughts on the subject, please do post in the comments below. This experiment may be over, but I’d still love to hear your perspective.

Emily Troscianko
Source: Emily Troscianko

Our survey findings on reading and eating disorders

As for what it’s taught me so far about reading and eating disorders, you can read the full report in my Journal of Eating Disorders paper, open-access here. Meanwhile, here’s the very high-level summary:

  1. People read a lot, and they perceive what they read to have significant effects on their mental health, for good and for ill. 
  2. Many people seek out books specifically to help them tackle their eating disorder, and read books recommended by others, and recommend books to others: most obviously self-help books, but other nonfiction and fiction of many kinds too. 
  3. Reading (any kind of book) can have many apparently powerful health-relevant effects. On the positive side, these include putting your disorder into perspective as something other people have experienced, seeing your disorder through someone else’s eyes, informing you about the facts, inspiring you with positive role models, and motivating you by giving you an idea of what recovery, or life after recovery, might be like. On the negative side they include making recovery seem more daunting, reducing your confidence in the possibility of full recovery, making you overcritical of your choices or achievements, confronting you with negative role models, and making you more obsessive about disorder-related things. Fiction in particular also has the potential to create an interpersonal connection, with someone possibly far removed from you in time and space, that makes you feel less alone; to distract you from fear or discomfort (for example, when starting recovery and having to eat more and differently); and to generate liminal experiences, of being immersed but not completely, that may have interesting therapeutic potency too. (See my resulting book chapter on immersion and related phenomena here.)
  4. When it comes to fiction in particular, there’s a stark difference (with high statistical significance) between reading fiction about eating disorders (e.g. where the main character has an eating disorder) and reading whatever other type of fiction you like reading (anything from scifi to romantic fiction). The effects of reading ED fiction seem to be overwhelmingly negative, on all the dimensions we investigated in detail (mood, self-esteem, how you feel about your body, and diet and exercise habits), while other fiction is, predictably, much more mixed, but is generally neutral or positive in effect, and especially beneficial for mood (see Figure 1). 
    Emily Troscianko
    Figure 1: Impact on mood by fiction type and presence/absence of personal eating-disorder experience
    Source: Emily Troscianko
  5. Quite a lot of people also seek out ED fiction deliberately to make themselves worse: more obsessive, more competitive, more caught up in the eating disorder mindset. (I should perhaps have expected this evidence of ‘self-triggering’, but I admit it shocked me.)
  6. There are centrally illness-related reasons why people who might derive benefits from reading don’t read, especially loss of the ability to concentrate, and guilt at sitting still instead of exercising. Not being able to do something that might otherwise be helpful can help create powerful feedback loops that exacerbate the disorder – just as breaking into them can reverse the vicious circle and help make recovery self-sustaining. (See my resulting chapter on feedback in reading and disordered eating here.)
  7. Being ‘high’ literature is no guarantee against negative effects. (My speculation on this: our respondents were overwhelmingly female (847 out of 885), and the literary canon is, after all, like the rest of the world’s fiction, bursting with examples of heroines defined by their slenderness, physical weakness, emotional fragility, dysfunctional stress responses (including stopping eating), all of which is often idealised and/or assumed unquestionable. It’s easy to come to believe that this is how women are and should be, and that qualities like physical or mental strength or competence are somehow anti-feminine.

You can find slightly more detailed summaries of the main findings in my articles for Medium.com, here, and The Conversation, here, as well as a longer piece on the importance of expanding research on creative bibliotherapy for eating disorders in the journal Medical Humanities, here.

Making the personal connection

I wonder how each of these findings resonates with your own experience – whether you’ve had or currently have an eating disorder, or whether you’ve had experience of other mental (and/or physical) health problems or not (as I said above, please feel free to post your thoughts as a comment below). Asking myself this question, this is what I conclude:

  1. I read an awful lot the whole time I was ill. I don’t think the reading – as distinct from the framework of academic over-achievement it was contained within – was very relevant to my illness one way or the other. But of course I can never know that for sure.
  2. I never read anything about eating disorders while I was ill, with the exception of a few self-help books and scientific papers, usually recommended by my mother, and my instinct was to avoid books on the subject just as I avoided websites and support groups and everything else. It simply never occurred to me to use reading therapeutically. At least, not the reading of books. Magazines were a different matter. They were second only to food as objects of hoarding for me: I asked in shops for leftover newspaper supplements, spent literally hours a week rifling through recycling bins at college for ones that had been thrown away, spent a good chunk of every evening before my eating rituals began ‘pre-reading’ them to get through the boring bits and mark eating-worthy passages to savour with my food, and felt incapable of eating without the hazy-yet-focused mindlessness that comes with reading something utterly trivial: my favourites were fashion- and cookery/restaurant-related. I also interspersed eating rapidly while reading with writing about the magnificence of eating – thus prolonging the pleasure, but also always endangering it, as the over-analysis of pleasure always does. There’s quite a bit of research on the therapeutic uses of creative writing, as opposed to reading, including some for eating disorders specifically (see East et al., 2010 for a review of existing work and a preliminary trial involving unstructured expressive writing as well as a writing task designed to prompt perspective-shifting). But my writing habits trod a similar precarious path to the one reading so often does: between heightening insight and reinforcing illness. 
  3. The self-help books I did read, most memorably Christopher Freeman’s Overcoming Anorexia, definitely did some powerful cognitive perspective-shifting for me. With Freeman’s book, my mother had read it first and marked in pencil passages that struck her as particularly relevant to my experience, or as questionable. So reading it made me both see myself in all the lists of symptoms and little case-study vignettes of the main text, and see myself through my mother’s eyes, and the net effect was a strong contributor to my second recovery attempt. The experience was at once comforting (I’m not the only one) and deflating (I’m just like everyone else), as well as galvanising (other people have done recovery so I can too).
  4. As I said earlier, I barely read fiction of any kind that I wasn’t formally studying. When I had choices about what to study, I never gravitated towards texts written by women, or more recently than a hundred years ago, which might have been more likely to address subjects related to bodies and food. I kept it all at arm’s length, probably for better and for worse.
  5. Had things been just a little bit different, I can imagine having been one of the people who went down the self-triggering route, back then. I didn’t, not even with Sylvia Plath or anyone else at the artier end of the wider misery lit genre. But had I been a little less solitary and a little more inclined to spend time and effort on anything except my work, I easily might have.
  6. For me, the reason for not reading anything I’d loved as a teenager – anything from the Brontës to Tolkien to Du Maurier – was not being prepared to spend even a minute doing anything that wasn’t either a) directly academically worthwhile or b) absolutely undemandingly predictable. I didn’t want reading matter that felt even remotely like work but wasn’t. And I didn’t want reading matter I enjoyed while eating to make me think or feel anything, because that would have distracted from the perfection of the eating, which was the only reason to go on living. So the lack of book-reading wasn’t driven by the guilt of not exercising, as many people’s seems to be, but instead by the guilt of not working. Even the last thing I read before turning off the light had to be something work-related that might then have the chance of percolating into my sleeping mind to useful effect. And alongside and underneath all of this I think there was also the diminished ability to feel anything at all, to care about anything at all (except eating, and, as a proxy for life purpose and a practical reason to defer eating, work), to let my imagination roam. All things, of course, that literature often encourages so skilfully, and might have helped me do – but that food was more urgently needed to make possible. This is one of the entrapping feedback loops I explored in the chapter I mentioned earlier: the eating disorder makes you unable to read, which deprives you of the benefits of reading, which exacerbates the disorder, which makes you more unable to read…
  7. The myths of our childhoods can do us untold damage as well as giving us untold strengths. In particular ways if we’re girls. All the fairy tales of impotent female objects of male striving; the adventure stories where the boys do the real adventuring while the girls fret about getting the kettle on; the novels and poems and epic sagas that recreate the misogynist norms of their generations, with rebellion usually absent, partial, or punished – all these were mingled with my blood as early as I could read, or listen to my parents reading. The canon overlaps with the last of these categories, and it takes no heed of politics – rightly so. We shouldn’t rely on any definition of art to be related to any definition of wellbeing. The two are not complementary categories, nor are they necessarily antagonistic. They’re just separate. As someone who devoted more years of her life than most to the classic white male Western European canon – Kant, Rousseau, Diderot, Goethe, Schiller, Lessing, Nietzsche, Rilke, Kafka, Thomas Mann, Sartre, Brecht, Grass, and on and on – I have no doubt that all those men’s often wonderful words, and my near-worshipful engagement with them, will have contributed to strengths and weaknesses in me that I’ll never fully understand. This project is, amongst other things, probably the start of trying to, partially.

Beat and me: The ethical complexities

I’ve never written about any of this for the blog before because Beat asked me not to mention our partnership here. We never agreed a statute of limitations for that self-silencing, but three-and-a-half years after my fellowship ended, I suppose it’s safe to assume it’s expired. In other ways we worked well together: Jon gave his time generously to co-designing and then solo-managing the survey, I wrote a guest piece for the Beat blog, the work got done. But it was a shame not to be able to share my progress or invite survey contributions here on the blog.

The reason for the moratorium? Well, Beat have a set of media guidelines which set out principles for responsible representation of eating disorders. Most of them are sensible, a few of them seem to me questionable, and the research they’re based on was a mixture of small-scale surveys and accumulated institutional wisdom. The charity told me that my blog contravened their guidelines in two main respects: mentioning specific bodyweights, and including pictures of me very ill and thin. They also mentioned the risks of enumerating food-related habits, as I’ve often done, but this one wasn’t a deal-breaker.  

The resulting stand-off raised interesting questions about things like: the gap between the research and the charitable agendas, the nature of evidence, the relative merits of doing good and avoiding doing harm, the phenomenon and the effects of ‘triggering’ – none of which I’ll go into in much depth here. I was disappointed by their inflexibility and refusal to engage in debate, but at least their stance was clear and our way forward equally so. 

Having given it some thought, I returned to the (mostly early) posts where I mentioned bodyweights and removed them; in the end, the numbers are arbitrary, and any given number can be one person’s anorexic beacon and another’s recovery target. Sometimes flagging the over-salience of tiny changes in the arbitrary numbers is important to conveying the sheer extent of the obsession – but then the figures after the decimal point tend to do the trick. 

For me, though, the pictures are another thing entirely. I’ve never used any image, of myself or anything else, gratuitously. I accept that anorexia doesn’t always involve emaciation, and that not all eating disorders are anorexia, and of course that anorexia should get no more airtime than any other eating disorder (not least because most people move between diagnostic categories during the course of their illness anyway). But I, like many other people, had anorexia, and I was very thin while I had it, and the starvation which causes the very-thinness was the same thing that caused almost every other physical and psychological symptom of the illness. Prohibiting pictures of it is therefore brushing a central part of the truth under the carpet. I accept, too, that images of emaciation can be used for the wrong purposes, doing damage to those who look at them, whether the person who made the picture public intended that or not. But I understand, equally, the power of these images to do good: to make real the great gulf between the sick person and the healthy, to make visible the inseparability of physical illness and psychological, to bridge the gap between the power of verbal understanding and the different power of perceptual recognition. 

When I use images of myself, ill, the words contextualise the picture and the picture the words. That isn’t to say they can’t be decontextualised: Google Images is great at a literal version of that, and human minds and fingers are equally good at scrolling past text to get to pictures, or discounting text in favour of pictures (or pictures in favour of text). I’m sure that some people will have found in these images reasons to harm themselves further; I know that some people have found in them a little more insight or strength to end and heal the harm. The conclusions to be drawn from this are, to me, obviously not obvious. For example: I will never know the precise numbers of people helped or harmed; not even those who have been affected, one way or another, will always know or remember precisely how; our own understanding of cause and effect is only ever partial in both senses of the word; and sometimes short-term pain is a necessary step on the way to longer-term healing. 

Beat have decided that images, especially photographs of certain emaciated body parts are triggering – ribcages, concave stomachs, collar bones, sternums and spines. Tops of arms that are shown as the same circumference as wrists, or thighs the size of knees are also unhelpful. 

In this case they also apparently decided that ‘triggering’ and ‘unhelpful’ are the same thing, and that both mean ‘may not ever be shown’. This reason for keeping our collaboration off this blog seemed to me to neglect the complexities here. In effect, it places a do-no-harm ideal undebatably above other reasonable aims, like doing potential good despite potential harm. And that’s understandable: they have charitable responsibilities that reduce their flexibility, and once explicit guidelines are in place, there would have to be a strong reason for being seen to condone contraventions of them. Still, I think they might usefully direct more resources towards expanding the evidence base for those guidelines with an eye to the inevitably powerful differences in context, textual and readerly. 

And all this brings us back to reading. Just as I know that some of my blog posts have made some people feel upset, angry, shaken, even betrayed, and just as I know that those same posts, and others, have given people hope, courage, clarity, and determination – so anything we read, like anything we encounter in any form anywhere, has the capacity to do us good and to do us harm. And that’s ultimately because we are not passive objects to which things are done by stimuli. We filter, we process, we behave accordingly and inconsistently, we remember and recreate as we remember, and everything else that has ever been part of our lives and minds shapes every encounter with any single sentence or image. To this extent, as one of our survey respondents put it:

I would suggest that, in my own experience, ED books have brought both comfort and destruction to my thought processing, depending on whether or not I am healthy. However, when I am ill, I can twist the words of ANY book into a message to support my disorder. For me, it is not the genre, as much as it is the state of mind of the reader.

If your eating disorder is entrenched enough, or just empowered enough in that particular minute when you find something to engage with and interpret, it can turn anything to its purposes: by being over-selective, by egregiously misinterpreting, by overgeneralising, and by means of any number of other cognitive distortions. And so, as one survey respondent reported, a text about someone who dies of anorexia can become a text that makes you feel jealous for a long time after reading. On the other hand, if that kind of thing carries on for long enough, intensely enough, the counter-momentum may also start to build: the miseries of illness may become clear enough that even recovery might start to seem preferable. I’ve considered the timescales of illness, insight, and conviction in other posts (in a sceptical look at early intervention, here, and on the seduction and honeymoon of anorexia, here), and reading words and looking at pictures – for apparent good or for apparent ill – is just one of the infinite factors that play into the complexity of anyone’s experience of illness and recovery. 

Where next?

As for the future of this research: I’d like to build on these survey data by conducting some systematic experiments that try to disentangle some of the many textual and readerly variables to draw more confident conclusions about cause and effect. Or, more precisely, as my activities take me further from full-time academic research, I’d love to collaborate with or advise someone else in doing so. (Let me know if you’re a researcher and you’re interested!) I think a combination of short-term studies of immediate effects of exposure to different textual features (say with variation in use of metaphor, perspective, descriptive imagery) and a longer-term efficacy study (does reading a group of texts over a period of months generate different outcomes for the test cohort from a control group?), would be a good way to go. This research might require and entail contributions to the mainstream of eating disorders research, like maybe generating a more fine-grained scale of recovery phases to gear recommendations towards. In this, it would be part of the gradual movement that’s urgently needed in eating-disorders research towards more standardised assessment protocols (Khalsa et al., 2017), and part of the broader progress towards more genuinely personalised medicine.

Recommendations for reading better

Because (contrary to the standard ‘all reading is good for you’ line) it’s all so bloody complicated, I hesitate to make any recommendations based on the research we’ve done so far. One of Beat’s practical goals on entering the collaboration was to generate evidence-based guidelines for the reviewers who contribute to their book review page: on what grounds, especially once one strays out beyond the territory of self-help, should decisions be made about what the charity’s service users might find helpful, or unhelpful? Can we say anything more than something commonsensical about avoiding books that obviously glamorise eating disorders or provide too many handy tips for people ‘wanting’ to make themselves more ill?

With all the caveats I’ve already raised, about the limits of self-report (is what you thought an effect was really the effect, and the only effect?) and the importance of taking the long view (could a negative effect today help bring about a positive effect next year?), and some others about the particular survey method we used (many people were clearly recalling episodes of reading from quite some time in the past) – the most confident thing I can say for now is: if your main aim is to minimise the likelihood of making yourself more ill, stay away from fiction, memoir, and other narrative texts about eating disorders, and read any other kind of book you enjoy, ideally one that doesn’t objectify anyone in shape- or weight-related ways. (Obviously determining this before you start reading something is rarely easy, which is where tailored book reviews might come into their own – though then they’d always be potential fodder for those looking to self-trigger…)

If you have a different primary aim, like increasing your insight into what your illness is doing to you, you might find the eating disorder-specific narratives helpful. But collectively, our 885 survey respondents made very clear the ease with which increasing insight can slide into heightening obsession. This is an interesting counterpoint to the standard theoretical model for bibliotherapeutic effects, which involves the reader identifying with characters that are similar to you, which generates insight into your condition, which gives you the motivation to solve your problem along the lines that the character did. Our findings suggest, in stark contrast, that reading about people in quite other situations might be less dangerous and more helpful. Other people’s research suggests that the danger may be less if you’re already actively engaged in recovery rather than just contemplating it (Shaw and Homewood 2015), but of course conviction during recovery varies hugely, and one person’s confirmation of the awfulness of illness might be another’s siren song back to it.

So if you are considering reading anything about eating disorders that isn’t a self-help book (and maybe even including self-help books), ask yourself before you do so: what are my motivations for doing this, really? Is part of me wanting to titillate myself with gruesome details to maybe in equal parts horrify and attract? If the answer to this is even a tentative maybe, consider doing something else instead. And if you find yourself reading anything at all and reading it with an attitude that you recognise as eating-disorder-filtering (looking out eagle-eyed for mentions of eating and not-eating, or size and shape and weight; comparing yourself with a textual character on disorder-related dimensions; discounting the negatives and exaggerating the positives around not-eating or being thin), ask of yourself some basic mental housekeeping: 

i) identify what you’re doing, 

ii) ask yourself how it’s affecting you, and 

iii) ask yourself whether can do anything different. 

Doing something different might involve actively broadening your focus on the text, for example by asking yourself what else you can learn from what you’re reading, or just putting the book down and doing something else: going for a gentle stroll, listening to some music that makes you feel better, or whatever else feels healing to you.

Ultimately, we all have to take responsibility for our reading habits and how they change us. Any text can be a ‘trigger’; but you are not a passive recipient of triggers. We choose, for example, what corners of the internet to hang out on, and so we shape the likelihood of our exposure to different kinds of text (and image). Surprises are always possible, and life would be dull without them, but discomfort is not trauma, and a trigger is not a death sentence. Perhaps the most useful health-related principle to bear in mind as you navigate the world of all that needs interpreting is that blanket avoidance is never a lasting solution: when you’re very vulnerable, seeking out pro-ana Instagram accounts isn’t the best idea, but building up confidence in your ability to see through, say, the diet/fitness lies is just good practice as a citizen of the virtual, material, social, and cultural worlds. This work of self-exposure is more effective the more controlled it is, and there’s something to be said for the book versus the website here: at least a book can’t catch your eye with pop-ups, seduce you with personalised ‘if you liked this…’ recommendations, or connect you with others who have the same vulnerabilities. That said, books can be terribly hard to put down even if we know we should, and the inaccessible prestige of a long-dead writer may make their aura of authority all the harder to reject. And though fearful avoidance may (as with self-weighing) only reinforces the fear, simply choosing not to give the rubbish much space in our mental lives can be as good as any exposure therapy.

All this has involved a bit of dissonance for me because in the year or so before I started recovery I wrote a novella called The Cat and I, a work of lightly veiled autobiography that explored the ambivalences of illness and recovery through a cat–girl relationship with smatterings of not-quite-realism. (I shared the opening chapter in an early blog post, here) I still have a fondness for that story, and an inclination to do something with it some day. But I think before I do I’ll have to give very careful thought to how to pre-empt, as creatively as possible, all the ways in which the disordered mind can turn exploration into validation, or a cautionary tale into a eulogy. It came through so powerfully in so many of the survey responses, just how strong the ED-filter can be. So, letting the disordered mind think it’s getting what it wants while actually giving it something entirely else is a fun challenge, and one that the book I’m currently writing tries to do a little bit of (forgive my slowness – I’m fully aware that I said I’d be getting down to work on it properly in 2015, but it's coming along well now!).

But meanwhile, be careful with your reading, and be not too careful. Remember the capacity of words used skilfully to seduce us into positions of impotence, and of potency. Remember that words – in whatever ways they come packaged, from hardback to paperback to magazine to newspaper to website to social media account to email and text message to your own secret diary with or without the pointless little bendy metal key – can create traps and spring them, can narrow down our minds and fling them open, can separate us from other people and connect us despite time and space, can help us pretend that life can only ever be this way and remind us, insistently, that it can be many other things we’ve never even dreamed yet. Words can, too, be pragmatically useful, not least as distractions from the difficulties of here and now. And this, too, can be its own trap if it becomes an addiction.

There’s only one fiction-reading experience that I remember with any sense of anti-anorexic significance, and that happened a few months after I’d begun to eat more again, the last time round. I’d had a strange psychedelic experience that day which had left my mind looser and more stratified than usual, and in the evening, after eating many unusual things that day and then all my usual things as usual, I returned to the book I was reading, John Fowles’s The Magus. If I have a favourite book in the world, it might well be this one. If you haven’t read it, do. It takes the rug out from under your mind with the most deliciously cumulative subtlety, and that night it did so in dreamy many-levelled ways which I read as a sign of things to come: that food was changing me, and that at last I was open to being changed.

At some point in recovery, I realised I wanted to read fiction again. My then partner recommended James Clavell’s tremendous Asian Saga, and the scope and pace of those volumes helped momentum gather in my new habit of reading for unadulterated if complex pleasure. Now I love reading instead or as well as watching something before sleep (in case you’re interested, my current book is the surprisingly not-rubbish proto-chick-lit that is Alice Adam’s Superior Women (1984), which found its way somehow on to the bookshelf on my boat). I find it strange to think back to all those years where reading was primarily a duty and a chore. 

So, if you want to recover from anorexia, eat more. If you want to recover from bulimia, stop bingeing, stop purging, and start eating regularly and generously. The basics are nothing new. But words can be there for you, to reinforce your decision to eat differently, to support you while you do. In particular perhaps as that pragmatic tool for distraction: much is said about the merits of mindful eating, for people with eating disorders and for everyone else, but in anorexia, the non-negotiable thing that needs to happen is more eating, and in bulimia the non-negotiable thing that needs to happen is more eating that isn’t bingeing or vomited up afterwards. And if imagining yourself in Rivendell or the Yorkshire moors or outer space can help you do that – well, then let your mind roam as the food strengthens it.

References

East, P., Startup, H., Roberts, C., & Schmidt, U. (2010). Expressive writing and eating disorder features: A preliminary trial in a student sample of the impact of three writing tasks on eating disorder symptoms and associated cognitive, affective and interpersonal factors. European Eating Disorders Review18(3), 180-196. Direct PDF download here.

Khalsa, S. S., Portnoff, L. C., McCurdy-McKinnon, D., & Feusner, J. D. (2017). What happens after treatment? A systematic review of relapse, remission, and recovery in anorexia nervosa. Journal of Eating Disorders5(1), 20. Open-access full text here.

Shaw, L. K., & Homewood, J. (2015). The effect of eating disorder memoirs in individuals with self-identified eating pathologies. The Journal of nervous and mental disease, 203(8), 591-595. Paywall-protected journal record here.

Troscianko, E.T. (2018). Fiction-reading for good or ill: Eating disorders, interpretation and the case for creative-bibliotherapy research. Medical Humanities44, 201-211. Paywall-protected journal record here.

Troscianko, E.T. (2018). Literary reading and eating disorders: Survey evidence of therapeutic help and harm. Journal of Eating Disorders6, 8. Open-access full text here.

Troscianko, E.T. (2017). Feedback in reading and disordered eating. In M. Burke and E.T. Troscianko (Eds), Cognitive literary science: Dialogues between literature and cognition (pp. 169-194). New York: Oxford University Press. Abstract here.

Troscianko, E.T. (2017). How should we talk about reading experiences? Arguments and empirical evidence. In T. Koblížek (Ed.), Aesthetic illusion (pp. 237-271). New York: Bloomsbury. Full-text preprint here.