The topic of eating disorders has been in the media a fair bit recently, and a recurring theme is that of ‘choice’. So for what it’s worth, here are my (unfinished) thoughts on the subject. I wonder what it will take for society to realise that eating disorders are no more an active choice than any other mental health problem. I also sometimes whether we need to think differently about the role of choice within recovery.
The issue of cause and mental distress is complex, and I definitely can’t claim to know even half of what there is to know about it. However I do believe my own issues were, at least initially, linked to experiences of not feeling safe. It’s also fair to describe my temperament as being somewhat ‘anxious’. I can be a bit of a perfectionist. I don’t know how much these ‘vulnerability factors’ are linked to early experiences, or how much is just ‘me’. Obviously we don’t choose our biology, early life experiences or environment, and placed within this context, I didn’t choose to develop anorexia. I didn’t even know what eating disorders were when I began to restrict my food choices. My aim was to be ‘disciplined’, to ‘take control’, improve myself. Given that I never needed to lose weight, it wasn’t a ‘diet gone wrong’. On reflection, I did feel unable to say what I needed, and I did find that focusing on weight helped me to feel more in control. I would say anorexia gradually took over. At the same time, culture, diet and food trends do tap into the ‘anorexic’ love for rules, self discipline and pushing things to the limit.
The issue of choice is a thorny one for me. I often feel tremendously ashamed of (still) having an eating disorder.As much as I’d like to think it isn’t my fault, no one can force me to change my eating apart from me. I am the one stuck in this and I have to change it. I know it impacts on others and I know it can appear selfish. I also feel guilty for making the ‘recovery focused’ choices I am now making, and allowing myself to gain weight. Going against ‘anorexic’ thoughts by choosing higher calorie foods and eating extremely regularly, still feels all wrong. The result of this is that it doesn’t always feel like ‘choice’ when I slip up and find myself working through lunch, skipping things, choosing something ‘safe’, or being more active than is helpful. Sometimes it just feels reasonable. Other times, I’m probably aware that it is ‘punishing’ yet I do it anyway, because I’m angry and frustrated. My awareness seems to vary. But on some level, I am making choices. And recently, the accumulated effect of this has brought me the closest I’ve probably ever been to my personal definition of ‘recovery’. The fact that it all feels so difficult tells me I still have some way to go, even setting aside my tangible ‘weight’ goal. I always believed I ‘chose’ to not eat, to remain underweight, but so far, eating more has been such a battle and so anxiety provoking that I recognise that other forces are at work apart from pure capacity to choose. I do now have increased awareness, and with that comes responsibility. I have to capitalise on it. Now, at this moment, perhaps I do have more opportunity to make ‘recovery focused’ choices. What I do not choose, is the distress and guilt I still feel when I eat.
It seems that when we reduce change down to a simple choice of ‘going against the anorexic thoughts’ or ‘choosing recovery’, it carries an implicit judgement that those who aren’t able to do this are just not trying hard enough, or are deliberately choosing to ‘hold onto’ their eating disorder. When people trot out cliches – ‘I recovered and you can too,’ it sits uncomfortably. Because actually, we don’t all start from the same place in life, we don’t all have access to the same opportunities, and we haven’t all had the chance to build the groundwork for change. But I suppose I would say that, because I’ve never been a healthy weight as an adult. Maybe it’s just looking for excuses.
Consider the variables that make change possible. Even leaving aside apparently straightforward issues such as access to treatment. Social factors can be complex: is a person’s home environment supportive of recovery – and is it experienced as supportive? What about opportunities to build a life beyond an eating disorder – education, work, satisfying relationships and financial stability? What about the person’s sense of confidence that they are able to make and sustain change, that they are ‘allowed’ to change and deserve something better. What about their ability to tolerate the emotional distress and uncertainty that come with the process of weight restoration or resisting certain behaviours? And what about the impact of the physical effects of starvation, which to varying degrees can make it difficult to think flexibly, and become self perpetuating? And eating disorder ‘symptoms’ generally serve a function – they have, at one time or another, enabled us to survive some degree of psychological pain. So change is difficult.
The trouble is, in order to untangle yourself from an eating disorder, you do have to begin to make significantly different choices. And those choices have to be repeated relentlessly, when you feel like it and when you don’t. And the learning grows over time. And people do manage to do this. Sometimes that choice is not entirely your own, you might get so exhausted and tired of being trapped by your own mind that desperation forces you to act, to consider the possibility of asking for support, to keep going to appointments even when the things you talk about feel acutely exposing. Sometimes other seemingly unrelated things shift, and that opens up the possibility of making different choices. Other times, things shift negatively, change becomes more difficult, and that isn’t always entirely within our control. And other changes are so subtle as to be almost invisible – acknowledging that maybe I am a bit trapped, maybe there is a better way – and then feeling guilty for allowing yourself ‘off the hook’ so much that you even considered such a thought.
I’d say my ability to change was significantly reduced when working in my old job (long hours, emotionally draining and almost no energy to think about myself. I also really needed the reassurance my eating disorder gave me). I haven’t always had supportive relationships. I haven’t always felt able to ask for help. I think without outside help I would definitely still be confused about which attitudes and behaviour were the eating disorder and which weren’t. I still am sometimes. But right now I’m in a situation where I can do things to increase my likelihood of consistently making the choices I want to make. I can ask people to help me. I am also in a place where I want to make those choices.
The reality is that circumstances do change, individuals change, family systems change, barriers can be removed, new opportunities present themselves – and that is why the possibility of recovery is always there. Because change, in some form always happens. And often there are things we can do to improve our chances, and things other people can do to make it easier for us to make helpful decisions. But let’s not be so naive, or worse, blaming, that we boil it all down to individual ‘choice’.