"Control" and Anorexia Nervosa

I wrote this article way back in 2009 with the evident enthusiasm of my younger years:

This article has been written to all those in the helping professions, to ensure that regarding anorexia, that the 'c' word is used sparingly and with insight and compassion. Thankyou.

Too many people have said to me: “oh, anorexia. That's all about control.”

And this comment from my GP wasn't helpful: “of course, you need control.” The 'of course' was in response to me saying I was eating better, but restricting fluids.

So I'm writing to express my frustration about the word “control” and those who've irritatingly used it in conversation with me. I don't think there's any other word that annoys me so much. In conversations about ED's it's the only word that will instantly get me bristly.

I've thought it through in my head. I've had to devise some terms of peace with the word, so that when the next person says 'oh yes, anorexia, that's all about control' I don't burst or scream. This is what I've figured out:

1. The person is deluding themselves if they think that wanting control is an aspect of mental illness ie. some bizarre obsession and flaw in people with anorexia

2. Even if the person thinks that giving up all desire for control will fix the problem, I know it's not as simple as that. And I'll appreciate that their intention is to be helpful, but I won't add that pressure on myself with another mantra: “give up all desire for control and eat and be well; give up all desire for control and eat and be well”

3. The person has probably not looked at the whole aspect of control to realise its significance in their own lives in order to be able to understand its significance in mine.

4. IT'S NOT ALL ABOUT CONTROL. People like simplicity, but whittling the complex issue of anorexia down to one word may seem useful, but it's not useful for me.

We might say anorexia is all about shame, rather than control; or perhaps it's some misguided form of hedonism (desire to feel good); we might say anorexia is all about getting attention; we could say it's an addiction; we could also say it's a compensation for attachment issues; or a disguised death wish; or a diet gone too far; or perfectionism gone too far; or that it's a form of self medicating...

I prefer to say that anorexia for me is an effective (though unhelpful) way of dealing with massive emotional pain and distress.

So, you can flip that around and call it control. Everything can be linked to control. I believe we call this game semantics. You can link everything to everything, just about. With any one thing I say about anorexia, we could trace it back to control, or to shame – though that may take some clever leaps, or to hedonism. That's what makes a good lawyer or politician – whatever you say proves their point.

So I don't mind arguing for the control theme, only let's dig deeper into it:

If by restricting fluids, I'm doing so for the purpose of control, then yes, I can see that. I am able to control what comes into my mouth; I am able to control my emotional state, and my physical state to some extent; I am able to bring about a dazed feeling, so that I feel partly out of touch with the world around me and then I feel like life is ok, and nothing matters, and I don't feel the pain of past wounds and current stresses; my anxiety is gone; I can feel weary so that I feel justified in isolating and resting; I'm controlling my boundaries – physical boundaries of food or fluid intake; interpersonal boundaries of how affected I am by other people; - “you can do whatever you like because it doesn't worry me, because I'm not thinking or feeling about that, since I'm consumed with the physical effects of restricting and the denial of my need for food and fluid”; and I'm controlling my own internal boundaries or how much I will allow myself to think and feel and be in touch with reality.

I've not specifically studied the topic of control, but I think I've got a good summary: every person naturally needs to have a fair degree of control over their boundaries – physical space and boundaries within themselves and with others. This is linked with our needs: food, fluid, shelter, love. We utilise control to make sure our needs are met and our boundaries are respected.

Very few of us deny our need for a toilet when we have the urge. We generally get the urge and before it's too late, we will find ourselves a place to go. Even if it means asking someone if we may use their toilet, or where we can find one. We will usually do our very best to find a proper place to go when it's time to go. Most of us control our comfort well, like making sure we're not too hot or too cold. We'll control our general safety, like walking on the footpath rather than down the middle of the road. We'll control the volume of the radio so it's not too loud for our ears or so quiet we can't understand it. Most of us would defend our rights like reminding a shop salesperson to give the change owed to us from a purchase if it had been forgotten.

So control is a part of everyday life for every one of us. Mostly, we don't consider that we're employing control to make sure we are not injured or becoming unwell or being literally or emotionally stepped on or flattened by other people. We're just taking care of ourselves and a lot of it is instinctive.

When I hear 'anorexia is all about control' or 'your problem is your need for control' I think “it's not at all about control, and you don't get it” or “it is, of course about control, but you don't get it.”

The difference comes when someone has a heightened need for control. Say, for instance, that I was sexually assaulted by a stranger in a public place one day, which I was. A man touched me, groping my behind, whilst walking past. I'm naturally going to be rather bothered by that. I naturally want to do what I can to make sure that doesn't happen again. I could decide never to go where there are strangers, which is a pretty drastic measure of control, and would limit my life a little too much. I could decide that I won't wear jeans again, or anything that would attract the attention of the opposite sex to that region of my body. Now you and I both know that avoiding a certain type of clothing isn't likely to prevent someone from assaulting me, but at the time, any semblance or misguided hope of control helped reduce my anxiety.

We're exploring one aspect of my basic premise that whatever we do, there's a very good reason for it, no matter how strange it might seem to someone else. It's linked to another of my basic premises, which is that we always do the best we can of that which we know and that which we're able to do.

If I'm employing control, then there's a very good reason for it, and I'm doing the best I know to manage myself and my situation.

Say for instance that my parents did not provide for me a sense of safety in the world, or a sense of being valued; and say for instance that their words and looks and actions towards me often felt like a dagger in my heart or a huge boot squashing me flat on the ground; and say my Mum fed me with her disapproving judgment and her well-intentioned manipulation and her angry silence. Then imagine that my husband who claims to love me, leaves me feeling used and completely rotten, messing up my head with his persuasive opinions. And say I'm pretty sure that no-one really likes me, that I'm just an intrusion, that I feel sub-human and nothing I do is any good. Then perhaps it makes sense to you, since it certainly does to me, that I would want to keep people out of my life and the world out of my life. And in an effort to minimise the effect of all this, and help me feel like I can go on without exploding or dying from the feelings, or killing myself to end it, I decide that I can consume less food and fluid and that's one way of taking in less of the world and of foreign things, and preserving my boundaries. I can imagine that I don't need anything, not food, not love. I can imagine that I don't even have a body, therefore, I wasn't abused, and therefore I don't need food. And when I discover that consuming less food and fluid makes me feel better, well, I figure that if I keep doing it, then I'll feel better and better until everything is completely fine and all my problems will go away. It's a fantastic way to feel separate from the world, like none of it matters, like I'm fading away to some la-la land. Memories fade… and emotional pain fades… thoughts are scattered and sense of self is vague. It's a fantastic control.

But when you say I'm employing control, it suggests to me that you think I ought to just stop employing control in my life. My use of control seems over the top to you, but to me it's entirely necessary.

Perhaps you have enough insight into anorexia to know that as the illness progresses, the restricting behaviour increases anxiety which creates an increased need for control. If I started out with a six out of ten need for control, it wont be long before my need for control is pretty well at ten out of ten. And my brain is now programmed to think that the best-by-far remedy for control is to restrict even more. And what I have is an addiction.

What I need, amongst other things, is to learn other ways of managing, ie. controlling the massive pain and anxiety.

So please don't summarise my behaviour with some flippant remark about 'control'. I'm not power hungry, I'm just trying to get through life. I don't want to have this illness. And though I've described the benefits of restricting, if I had the time and the desire, I could describe next the suffering and the torment. Please help me connect with what I want most and help me find the way to achieve that instead. I need to want to be free of this ED and to have the desire and the know-how AND the help to walk the difficult road out of the ED.