Content warning: eating disorders and anorexia
I was 30 years old when I developed anorexia and was profoundly confused as to why I no longer wanted to eat much. Before I started losing weight, I liked the look of my body and lived with a boyfriend who liked it too. I had a job and a place to live and no obvious need to grasp at a sense of “control” of my life.
And even if I had, there would have been people on hand with their own, opposing, explanations: that self-starvation wasn’t a bid for control, but rather consent to being controlled by the scourge of patriarchal beauty norms. Or in fact that it was all about hostility to these norms – all the better to avoid being ogled to a pulp.
We can’t, it would seem, agree if anorexia is more like an action or an affliction, a bid to be more feminine or totally unsexed, to be beautiful or grotesque, spectacular or invisible, rebellious or conformist. Either way, we assume the motivation will be self-absorbed – not worth the cost of the tissues in a psychoanalyst’s office.
Perhaps this is why the Maudsley Model of Anorexia Treatment for Adults (MANTRA), the one I was prescribed automatically by my local provider, is founded on an indifference to the illness’s root cause. Instead, based on brain scans, and research into cognitive and personality traits, this modern treatment model takes aim at the ways the illness manifests. Whatever social circumstances it comes from, MANTRA holds, anorexia is sustained by certain inherent, genetically grounded flaws in its sufferers’ personalities – sensitive, anxious obsessive – and in their “information processing styles”, heightened by the damage they have done to their brains, and leading to states of delusion.
Along with CBT-E (Enhanced Cognitive Behavioural Therapy) and SSCM (Specialist Supportive Clinical Management), MANTRA is about establishing a weight-gain goal and chivvying the patient towards it, through methods of education about the illness and its risks, and through forms of mental retraining.
Accordingly, most of the speaking that took place within my group was done by the two presiding therapists, who each took turns to explain to us the rules of good nutrition and the peril we had risked in disregarding them: the wastage we had visited on our organs, the shrinkage on our brains; the cost we were inflicting on society – out of work, in need of help.
The fact was that most of us knew about nutrition, and didn’t starve ourselves for ignorance of the dangers of its absence. Nor could training us to cultivate healthy habits make us fundamentally interested in health. We starved in a state of ferocious, overpowering fear, perhaps desire – to not eat. Though it is hard to make sense of why over a million people in this country would say no to one of the nicest things there is, it is also hard to imagine a recovery that could circumvent this question.
Sensing the futility of the exercise, I left the programme halfway through. When I did, the rest of the group still seemed as uninspired as ever to wake up and smell the calories. In the current clinical landscape, less than half of patients fully recover from anorexia. Those that do frequently relapse, perhaps because this recovery is defined, in large part, by nothing but fat.
When I revisited the prospect of treatment, then, it wasn’t until I came upon a programme that valued other things – less normalising my weight by whatever degrading means than exploring the state of my mind. In 2022, I signed up for a clinical trial that sought to study the value of psychedelic experience for anorexic patients. Psychedelics – literally “mind-revealing substances”, I thought, cannot moralise, shame or scold. Rather, by inducing a “hyper-plastic” state, in which you abandon all rote preconceptions, they help you open your eyes to what is buried within yourself.
During the trial I went on a series of day-long trips on high doses of psilocybin – the active chemical element in psychedelic mushrooms. After each trip, a pair of clinically-trained guides would help me make sense of it all. They never once mentioned nutrition, or put me on a scale, or appealed to my sense of shame. All they really did was ask questions about what I had seen “out there”; what I perceived, without the burden of others’ judgement, that might be putting me off my food.
As it happened: a great many things that had very little to do with myself, my self-regard, femininity, love-ability, beauty, thighs. The sense of powerlessness I felt on those mushrooms – floating for hours in outer space – reminded me less of how I felt in front of the mirror than how I felt in the world. Not just a woman, but a political loser in the broadest possible sense – a person of ideals adrift in what seemed like an ever more intractably unjust world.
Though we like to think of the rise of eating disorders in the West as timed with a crisis of feminine self-esteem, the late 20th century was also a time of rapid mass disempowerment. We continue to live in a social world that services finance capital at the expense of universally accessible healthcare, housing and food. We have learnt that the most we can do is look out for ourselves, and be grateful if we can call ourselves winners. Be grateful if we can eat, while others dumpster dive or die. Some of us, indeed often women, find we don’t want to – that it stops feeling good. What to do about this, short of dying?
It is easy to swallow the lie that it would be childish to hope for a better world. Easy, until it makes it hard to swallow anything at all. It wasn’t until I saw the nature, and the depth, of this dejection that I was moved to think about how it might be undone.
Responding to anorexia in a meaningful way requires that we hear its plea: at its most basic, for something other than the world in which it thrives. Treatments that exaggerate that world’s more ugly dynamics – misogyny, dogma, selective dehumanisation – will never get us far. What sufferers need is not to be made to apologise, but to be helped with believing in more – believing that we, as more than mere individuals, can do better. That there is something still to eat for.
Tell Me How You Eat: Food, Power and the Will to Live publishes on 5 Feb by Hutchinson Heinemann