Thursday, March 30, 2017

On Self-Control and Eating Disorders

Years ago, I had a friend who once described herself in a moment of honesty as having gone through a period where she was, as she put it, an exercise bulimic. She would exercise obsessively, going on runs every day and working out all the time. The label itself was perhaps the most interesting part, and seemed to be her own creation. We have mental categories for eating disorders. Most of us, however, do not have categories for exercise disorders.

Eating disorders, at least in the popular telling, are usually associated with looking excessively emaciated and thin. But instead of just not eating, she ate a more or less regular (albeit modest and vegan) diet and exercised like crazy. The result was looking thin but toned, not the stick figure arms that I always associated with anorexia or bulimia.

And this proved almost the perfect disguise, because someone who just likes to exercise a lot fits the aspirational ideal of our society. We envision them as ourselves but with more willpower, doing all the gym classes that we always meant to do but never got around to doing.

By contrast, someone who simply refuses to eat meaningful quantities of food, certainly in public, strikes many more people as inherently suspicious. Having willpower being channeled into straight self-denial of something so basic like food, rather than hard work on something "virtuous" (in the modern telling) like exercise, raises far more alarm bells about sanity. These alarm bells themselves are quite telling, of course. They arise because we live in an inherently self-indulgent society dedicated to consumption and self-centredness, where self-denial seems like a bizarre refutation of what we hold dear. But nonetheless, the perception was what it was.

I have known a number of girls over the years who claimed to have eating disorders at some point or other.

Parenthetically, I even knew one girl who claimed this was a very useful cold reading technique on women. Say to them "I'm guessing that you possibly had an eating disorder at some point, though you may not have ever told anyone about it." The reason it worked, she claimed, is that this described a sufficiently sizable majority of women in the population, so was a safe bet to make regardless of who you were talking to, especially given the ambiguity in understanding of the term 'eating disorder'.

But among those few who claimed to have an eating disorder, there were some things that stuck out.

Firstly, the claim was always in the past tense. I had an eating disorder some time ago, not I have an eating disorder. But the story somehow never made it clear that the underlying mindset had changed that much. The circumstances had changed, sure, but the stories tended to lack a defining end which stated "and that's when I figured out that I had to change my way of thinking, and so I did." Instead, the descriptions of past eating disorders always had a distinctly confessional aspect about them. I suspect my cold-reading friend knew of what she spoke when she added the clause about maybe not telling anyone about it. One does not lightly confess to things which sound like mental health problems.

People nearly always tell you the unflattering things about themselves in oblique ways, and you need to know how to listen. One way is the one above, and the rarer case, where introspection and honesty have gotten to the point of identifying flaws, but they are phrased in the past tense. When you hear "I was [this unflattering thing]", you should understand it to mean "I fear I still am [this unflattering thing], but I struggle and work to try to change it, with varying degrees of success"

The other way people reveal themselves is by generalization to the population at large, particularly when it comes to mental processes. Whenever you hear someone say "people generally think in manner X", pay close attention, especially if the characterisation strikes you as wrong. They are nearly always describing themselves.

My cold-reading friend, for instance, was not among those who had said they'd had an eating disorder themselves. But it would be a very good bet to make.

The second notable aspect of the eating disorder confessions I've heard is the rationale. And they all said the same thing: it wasn't really about being thin. It was about exerting control over one small aspect of their lives. And the need to do this became strong when the rest of their life seemed to be sliding out of control. The message in multiple cases was the same - "At least I can control this part".

Which fits in with the characterisation of the mindset above. What seemed to have changed to make the eating disorder go from present tense to past tense, if you read between the lines, was that the problems making their life uncertain had gradually subsided. That, more than anything else, was what caused them to no longer obsess about their weight and eating. Everyone wants to look thin, pretty and be in good shape. But what was being felt internally, and what sometimes but less frequently gets observed from the outside, is the excessive control. This was the underlying need - the food was merely the one part they could solve in a life that had gotten chaotic and frightening. In one case it was going to boarding school at age 13. In another it was being in a foreign country and suddenly knowing nobody.

I have a suspicion, though I'm sure many psychiatrists will disagree, that a decent amount of what we classify as mental disorders really represent points on a continuum of character traits, rather than binary instances of a disease. At some point, we have a general view that the threshold has been crossed into the pathological territory, but this is nearly always a judgment call on which people will often disagree. The distinction between being a clinical narcissist, a sub-clinical narcissist, and just a general selfish asshole, is not an easy one to pin down.

So it seems to be here.

The underlying tendency here is far more common in its less pathological form - that when you can't manage the large things in your life, you at least manage the small. You may not know where your relationship is heading, or how you're going to find a job, but you can at least get the laundry done and make sure the dish cloths aren't too dirty. At some point, I suspect a lot of us have done this, busying ourselves with the musical score of day-to-day activities while the deckchairs of our life slowly slide down the deck of the Titanic.

What we are really observing with something like anorexia, then, is that the need for control has gotten so great that the person can't even see how they appear to the outside world. Keeping yourself 10kg underweight is very hard work. The pathology is that the need to do something extremely hard and controlled outweighs even the need (or ability) to see that others will perceive you as being mentally ill.

And to be honest, this is a pretty good diagnostic of at least some instances when things have tipped over into pathology - when you can no longer even see how you appear to the outside world. But if one focuses only on this aspect, one tends to treat the symptom of the excess, but not think about the underlying cause, especially in the sub-clinical cases.

For instance, one of the girls I knew said that the lesson she had learned was not that she shouldn't obsessively control her weight, but rather that she needed to obsessively control her weight and weigh a few kilograms more so that people wouldn't think that she looked too thin.

It seems, shall we say, optimistic to think that this has fixed the underlying problem, unless you think that eating disorders are merely a problem of low BMI.

For those of us who are not psychiatrists and not dealing frequently with people who are genuinely mentally ill, the interesting thing about understanding pathological behavior is for what it reveals about how to fix our own, non-pathological versions of the same basic trait.

And I suspect the broader lesson is that you should be wary of dealing with the uncertainty and chaos of your life by focusing on the small problems in lieu of the large. Willpower is a finite resource. Spend it on the most important use.

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