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Anorexia Nervosa
Taking, Losing, and Letting Go of Control in Anorexia
A fault line in the grand edifice of control: chance and the unplannable
Updated October 24, 2023
Thomas Mann’s Der Tod in Venedig (Death in Venice) is, for me, one of the greatest stories ever written: both its beauty and its heartbreak are stiflingly intense. And it includes probably the most concisely effective description of character I’ve ever read. A ‘careful observer’ says of the protagonist, ‘“You see, Aschenbach has only ever lived like this” – and the speaker closed the fingers of his left hand tightly into a fist – “and never like this” – and he let his open hand hang comfortably down from the back of the chair’ (In the German original: ‘“Sehen Sie, Aschenbach hat von jeher nur so gelebt” – und der Sprecher schloß die Finger seiner Linken fest zur Faust; “niemals so” – und er ließ die geöffnete Hand bequem von der Lehne des Sessels hängen’). This man and this life have always obeyed the mantra of control.
Control is at the heart of many people’s experience of anorexia. One of the commonest and most satisfying single-line explanations of anorexia goes something like this: the sufferer attempts to take control of her life by exerting control over one section of her life, her diet and thereby her body, and illness develops when that exertion of control turns into its opposite, the state of being controlled by a pathological compulsion to control. Christopher Freeman, for example, remarks in Overcoming Anorexia Nervosa (2009) that
Often, individuals vulnerable to AN are in circumstances where they feel trapped and under pressure to succeed; or they feel out of control in their lives. The reward they get from exerting control over their food intake and consequent weight becomes of exaggerated importance and may begin to dominate their existence. (p. 12)
It’s hard to know where to start with something this big, and I don’t want to try to tackle control head-on, since that would make for a post even more interminable than my usual. Control has come up in some way or other in the majority of the posts I’ve written; I’ve often referred to it using the phrase ‘the illusion of control’. Here I want to try to sneak up on that illusion from one particular angle: the role of chance, or contingency.
Let me start with a little story. To understand it, those of you from elsewhere in the world will need two pieces of British background information.
Firstly, a narrowboat is a traditional type of boat designed for transporting coal through the English canals in the nineteenth century, originally horse-drawn and with very little space for anything but coal, now with engines and cabin space and popular with holidaymakers and those who prefer not to live in houses. My brother and I lived on the one pictured, called Lancer, with my father when we were teenagers, then again as students (my brother only for one year, me for seven), and we inherited our father’s half share in it when he died in 2011. I've recently been living onboard again, and she feels like part of the family.
Secondly, Waitrose is the best British supermarket chain: everything tastes better from Waitrose, and as part of the John Lewis partnership, all its employees are also shareholders. It has gentle fun poked at it for its solidly upper middle-class reputation, including via the ‘overheard in…’ meme, and it experienced an influx of a different kind of clientele when in 2014 it started offering all its cardholder customers free tea and coffee while they shop. My foolish Waitrose-themed hobbies include counting Waitrose lorries on the motorway, charting the progress of the new shop that’s being built in Oxford, and getting photos of myself at branches I haven’t visited before.
Anyway, this week I went for a trip on Lancer. My partner and I, and for two days my mother too, brought her back to Oxford from a place you could reach in an hour by car, but which took us a gentle five days to get back from by boat. We pootled along for hours a day, watching the canal and then the river float by, feeding ducks, opening locks, finding nice quiet mooring places at lunchtime and in the evening, being away from work and all the least savoury bits of the modern world and generally feeling like everything had slowed down to a tenth of its usual pace. As part of our silly Waitrose thing, we’d placed an online order to collect from a branch that we worked out we should get to by mid-morning of our second day’s cruising. In the event, we underestimated our speed (rarely something you end up saying when narrowboating), and found ourselves a few miles past the shop by the time we stopped on the first evening. We thought we might get the train there and back, and then in the morning I had the idea that we could run there and get the train back, since we’d been planning to have a little run sometime that week anyway, and it’s always nice to have an actual destination. So that was what we did, and it was fun retracing our progress along the canal from the previous day, and enjoying our free lattes while we cooled down and waited for our groceries to be brought to us.
What makes this a story about anorexia? Well, I caught myself at various points reacting to the distinct chain of contingency present in that sequence of events and decisions and their effects. There were all sorts of things that could very obviously have been different. It didn’t matter which of them were supposedly part of the plan and which felt more like hazard: each of them might very easily have been otherwise. There was my only brief look online for Waitrose branches around Newbury, there was a particular canal route planner to get a journey time estimate from, there was the time we’d agreed to meet the boat’s co-owners at the handover point, there was the advice from them to go and explore the little village and the fact of buying some quiche from the bakery for lunch before we set off, there was the loveliness of cruising along in the hot sunshine that day and not wanting to find a stopping place till it was quite late, there was the fact of just having a couple of cookies before running and then a big brunch afterwards, and of the shop being just far enough from the railway station and our bags of food and drink just heavy enough that we decided not to bother with the train and just call a taxi instead, which cost quite a bit but worked nicely… My reaction to all these interlocking mini-happenstances was for the most part simply to observe them with interest, but I think I noticed them at all as connected elements because there was a little part of me that remembered how it would have been.
Once upon a time my thoughts would have skated helter-skelter down all those alleyways of accident. And at every branching point they’d have paused for a millisecond before hurtling down alternative avenues of their own creation, unfurling their little counterfactual carpets in front of them just as fast as they ran, calculating with feverish speed everything that might have been, and what it would have meant if it had. There would have been calculations about calories in and out (was cookies plus run plus brunch more or less than breakfast and lunch and no run would have been?), about money spent or saved, about all the greater efforts at planning I could have made if I’d taken more time; there'd have been endless what-ifs about the weather and the journey and our timetable. And everything would have come down to one stark numerical outcome: had I eaten more or less than usual, and if so, was the variation somehow justified? Then, having worked through all my well-honed formulae of credit and debit, I’d have known where I stood, and could have taken appropriate action.
Of course, this particular fever of control-restoration could never have happened, for the simple reason that I’d never have ‘lost control’ like this in the first place. Going on holiday without planning all my eating in advance and taking with me anything I might not be able to buy, making decisions last-minute and flexibly together with someone else, spending lots of money on varied and interesting food and drink to enjoy with someone else – none of this was possible while I was ill. To get to the point where you can ‘lose control’ like this requires that you get past the belief that something like this is losing control, or is anything other than just living.
And that requires you to let go of the idea that life can and should be reduced down, in neat little tapering cones of contingency-tracking, from all its teeming variety to that single point: more or less, + or -, and all their giddying towers of association (success-failure, safety-danger, calm-panic). And that in turn requires you simply to try out letting contingency in for a while. After all, few things in recovery from anorexia can be changed without acting for a while as though they had already changed. I’ve talked about this before in the context of the house of cards image: if you pull out any card that's anywhere near the bottom, the whole edifice topples. The first card I tried pulling was stopping weighing one single item in my daily intake – and once there was even one value I didn’t know, insisting on knowing any of the others down to the nearest calorie or gram became instantly pointless. Then bigger steps can be ventured, whole handfuls of cards wrested from that teetering construction. The most liberating of all is probably starting actively choosing not to choose. You can wait and see whether your friend brings anything for pudding with her, you can wait and see what the weather does or whether the shop has any Pimm’s left, or just wait and see what you feel like.
Then three quite remarkable things might happen, one after the other. The first is that tiny little things can change everything. This is chaos theory: the flap of the butterfly’s wing can be the difference between a tornado and no tornado. Once you stop trying to micromanage everything in advance, you see that there was always a whole ocean of possibilities waiting, and that something as little as bumping into someone on the street can lead by big or little steps to something as big as a summer holiday somewhere different – and it always could have, if you’d let it.
The second thing is that you maybe start to realise that you thought you were scared of the chaos but you find you don’t mind it – perhaps you even like it, and find you can breathe more freely thanks to it. One fun little game to play here is an extension of choosing not to choose, called ‘Let the Decision Make Itself’. Pick a specific decision that needs making – whether to watch a film or read a book, or when to cross the road, or what clothes to put on in the morning – and think thoroughly through the alternatives. Then don’t make the decision. (NB: If you’re still at a vulnerable point in illness or recovery, be careful with this, and don’t choose food-related things, otherwise you risk distressing yourself and compromising your dietary intake. If you’re further along in recovery or post-recovery and feel comfortable doing so, try it with food too: what to cook for dinner, or what to choose at the restaurant. But remember, there’s no point in doing this if you’re still ill enough that there’s no question of you choosing anything other than the least calorific option.)
Now watch what happens – something will. One of the options you’d thought through will happen, or something else entirely. It’s lovely to know that there isn’t any need for some air-traffic controller You to take charge of things from up on high; that life will just get on with itself. Even if ‘you’ don’t know what ‘you’ feel like, someone (or some collection of instincts, habits, inputs and outputs) will act, and probably quite reasonably – and maybe sometimes surprisingly.
The third thing that happens is that you start to notice that the ocean of possibilities in fact obeys quite predictable tides. Chaos is the underlying reality, but the surface manifestation is predictability within a fairly narrow range a fairly large proportion of the time. So loosening that iron grip is unlikely to end up with you dyeing your hair rainbow-coloured in exchange for a donkey ride to Antarctica. Just as eating tends to find its mealtime rhythm with minor and despite major perturbations, so the difference between exercising control and letting things be is more a difference in attitude than in appearances. A day at home reading, tidying, drinking tea, and eating can be agony or bliss, depending on what you let it be.
As I said, this is only one little way into the thorny realms of control and all the ways its many paths tend to turn into dead ends. Maybe I’ll come back to it from a different angle sometime soon. The point I want to end with, perhaps as a starting point for a future exploration, is twofold.
Firstly, when we try to make everything taper down into the narrowness of one-dimensional assessments like calories or kilos, we betray the reality of existence. We therefore also lose real control: the more you shore up your defences against one particular type of imagined threat (say, weight gain), the more vulnerable you are to other, less expected things – you become ‘robust yet fragile’.
Secondly, when we think we have everything neatly tapered to that point – then we realise all we’ve done is create an explosion of contingent complexity somewhere else. One of the many dazzling faces of anorexia’s self-sustaining myth is that it involves a return to something simpler and purer, instead of the reality, which is giving in to tortuous and torturing energy-wasting complexities involved in working out how to try to stop the world being what it is, complicated. Every time you try to squish the mattress down in one place it pops up in another; or, to go back to the metaphor I used before, your apparently neat taper from past to future will unfurl into a fan of tiringly endless counterpossibilities.
The only way to step away from both is to let life be complicated, and all the parts of yourself be just that: parts of a vastly greater reality. This is one reason why 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.
***
You can read the immediate sequel to this post, 'Why control won't bring you happiness', here. And a later semi-sequel on making mistakes and the myth of the straight line, here.
