The ‘Control’ Fallacy

…over a decade of talk therapy and I was still no closer to recovery. That never felt like control to me.

Disclaimer Time

I know it’s frustrating that as a society we seem only to acknowledge Anorexia Nervosa (AN). It’s annoying as hell even to someone who has received it as a diagnosis.  I am in the process of continuing my research regarding other Eating Disorders. I believe ‘Atypical Anorexia’ and AN to be one and the same in that symptoms are more significant than body weight. Please be patient, as I aim to include only what I am familiar with at any given moment. For those of you who have engaged in any kind of restriction, this blog post is primarily for you. There is a more comprehensive article underway where I will feature multiple eating disorders.

Regardless of where you fall on the spectrum, I believe that this is something everyone can benefit from reading. Apologies if it reads too much like a dissertation, I spent so much time researching this that my personality got bored and nodded off at times. In writing this post, I gleaned notes from several different research papers before arriving at an impasse. When the contents exceeded several pages, I realised that I would need to approach this differently. I’ve decided to link all relevant sources instead of including all quotes from the papers. A summation for non-science folk, if you will.

Finally, please know that my intent isn’t to undermine the experience of anyone who may already subscribe to this theory. I am merely suggesting an alternative explanation that is consistent with the integration of a Darwinian framework along with the studied effects of malnutrition. Through research and personal experience, it has become apparent to me that the traditional Psychoanalytical theory of Eating Disorders (ED), along with the heavily endorsed ‘control ’ ideology are both riddled with inaccurate nuances. Although this particular therapeutic model has been passed on, resonating within the recovery community, it doesn’t adequately explain why the distinct symptoms of an ED develop.

This concept offers no acknowledgement of the unique biological forces that exist in opposition to recovery efforts. While trauma, environmental influences, or a poor self-image may be a contributing factor to the onset of a diet or restrictive eating habits, it is not the process through which the illness primarily operates. Many symptoms are a direct result of malnutrition, the archaic instinct as a species to migrate when famine is imminent and supportive reward systems within the brain.

Theoretical Origins

In the 1970s, Hilde Bruch, a respected psychoanalytic theorist of AN, proposed that food refusal represents a struggle for psychological autonomy and control. Her work tended to cast blame on the family dynamic, a system within which patients were supposedly ‘engaged in a desperate fight against feeling enslaved and exploited by their mothers’.

It’s worth noting that this theory regarding families has since been disproven, yet the ‘control’ element has endured. Bruch’s hypotheses provided the framework for future psychodynamic work that later empirical research did not substantiate. Further research has suggested that disturbed eating cannot be dismissed as a mere reflection of underlying psychodynamic turmoil. To her credit, Bruch did bring about a more compassionate stance regarding the illness and was known to chastise any professional who approached patients in a negative manner.

Bruch’s speculation seems to have permeated the work of social theorists in a vain attempt to explain why women and girls are more vulnerable to developing AN. In 1986, Susie Orbach wrote; ‘in controlling her food so very stringently she caricatures the message beamed at all women’. She then goes on to claim that the  ‘western patriarchal culture offers girls few outlets for autonomy, self-starvation becomes part of their struggle for liberation.’ Once again, we’re met with the same limitations as psychological theories in that they fail to account for the occurrence of symptoms in men, animals and throughout history.

Alternate Evidence

The distinct symptoms of restrictive Eating Disorders, namely AN, pre-date the study of psychology. For our nomadic ancestors, the ability to forsake hunger while in search of a more abundant environment was a crucial element in their ability to survive during famines. Distorted body image was actually part of this survival mechanism, whereby if one couldn’t perceive starvation induced emaciation, the stress of that could be largely overlooked. Several species of animals have demonstrated similar behaviour in tandem with the ability to ignore their base instincts in favour of migrating. These animals will not typically ‘eat and run’ if the search for food interfered with migration. While observing starved laboratory rats and lean-bred pigs with Wasting Pig Syndrome, researchers noted a consistent refusal of food and hyperactive behaviour.

There are multiple accounts of pious women fasting and later developing what is colloquially referred to as ‘Holy Anorexia.’ Diaries and firsthand accounts show that these women manifested typical AN symptoms of aversion to food, over activity and denial of starvation. In the case of modern Anorectic patients, fear of weight gain was not recorded in a therapeutic setting until the 1930s.

The increased incidents of Eating Disorders in response to societal pressure speaks to a society immersed in superficiality. Put simply, women and girls are taught that obtaining thinness is desirable, leading to an increase in dieting behaviour. This will inadvertently signal an activation of this maladaptive response. While psychological/societal factors may influence an individual in their decision to diet, the symptoms are more consistent with the behaviours observed in our foraging ancestors, starving saints and various models in animal behaviour.    

Starvation

The Minnesota Starvation Experiment is rarely brought up when referring to AN. It is the most comprehensive study of starvation with human subjects that we can refer to and has lent so much information in the realm of ED research. Knowledge that is almost ignored by supposed professionals, to varying degrees. The experiment was initially conducted as a means of determining a viable process of refeeding war-torn populations exposed to famine. Inadvertently, what also followed was further discourse over the effects of malnutrition and the parallels to AN.

Various symptoms in either instance are typically resolved when the brain is no longer under the influence of starvation. Bear in mind, these were perfectly healthy men who participated in this experiment and they found themselves completely obsessed by food and engaging in very strange behaviours. The only difference being that they were able to actively participate in the refeeding process, unencumbered by the biological influence of AN.

Addressing underlying trauma and related emotional distress may be necessary long term. In my experience, it seems pointless to attempt doing so when our cognition isn’t at full capacity. We’re still reactionary due to constant hangriness and talking does not solve this. Professionals seem unaware of the fact that malnourished individuals are highly suggestable and at times easier to dominate. The likes of Mussolini, Hitler and various other dictators throughout history used starvation as a political weapon. They would cripple entire populations simply by cutting off their food supply. Now, that is one aspect of control I am willing to acknowledge.

The Trap

Let me be clear; I believe that many of us are mere victims of an almost pathological desire to psychoanalyse everything. My own experience culminated in over a decade of talk therapy and I was still no closer to recovery. That never felt like control to me. Over the years, I’ve heard many similar accounts from other sufferers and it’s nothing short of infuriating. We’ve been fed this narrative by professionals and even from within our recovery community, yet many of us continue to fail in achieving full recovery. A recent informal survey I conducted across various support groups revealed that no one could definitively describe a feeling of ‘control’ and how it took place in their experience with the illness.

Many recounted what I believe is the reward we receive from engaging in certain behaviours, not a feeling of ‘control’ that is distinct and tangible. I asked several to extrapolate on this and explain how they came to this conclusion. It was really disheartening when several of them went on to relay elaborate psychoanalytic explanations that have likely been suggested to them. None of them seemed to have come to the conclusion without relying on an external influence. A separate poll revealed several others to have experienced a caloric deficit at some stage, yet no one I spoke to had made the connection and it seems to remain largely unexplored in a therapeutic setting.

But why refer to it as a ‘trap’? Well, if we were to view our ED as a complex survival mechanism, why would our brain cooperate with the notion of surrendering something it believes is keeping us alive? This illness evolves with the times and social environment in order to stay relevant to the experience of the individual sufferer. We’re emotionally driven mammals and that information is cognitively exploited in order to keep us in this disease. It is but another smokescreen created by our brain in order to keep us trapped in this illness; a deranged safety protocol. If we’re consistently distracted by a false construct as it pertains to this illness, how likely are we to simultaneously explore the idea of nutritional rehabilitation? I try not to ‘humanise’ my ED or refer to it as some kind of entity these days. If I were to use that as an example, that bitch will say and do anything to keep us in her clutches. The prehistoric brain tricks us into staying ill.

The Reward

So, I mentioned that our brain rewards us when we engage in certain behaviours. Within the ED community, I’ve observed countless references made in regards to feelings of ‘euphoria’ as they relate to the practice of certain compulsions. In 1996, Cecilia Bergh and Per Sodersten found that a reward mechanism was triggered in response to stress-inducing behaviour.

Corticotropin Release Hormone (CRH) is responsible for this rush of pleasure and is observed in higher amounts in individuals with AN or those who heavily restricted their food. Levels of CRH return to normal upon weight restoration. The stress of overexercise, restriction, purging and other compensatory behaviours are initially self-rewarding and conditioned over time. Similar to self-harm, these actions are perceived by the brain incorrectly and are pursued in order to attain a pleasurable sensation. This is largely what I believe is confused as ‘the feeling of control.’

Final Thoughts

Moving away from the long-held belief that my illness was purely psychological and about ‘control’ ended up being the catalyst for positive change in my recovery efforts. I’m not what I would consider 100% recovered and there have been some slips along the way. However, I noticed a decrease in symptoms I had previously attributed to trauma and poor self-image.

The idea that this is an archaic adaptation to starvation has resonated with me more than any psychoanalytical model ever has. If you take one thing from this, be it that you might begin exploring the theory further. Should you still believe that control is at the core of this, I’d love to hear of any relevant methods you have used to remedy this and achieve full recovery as a result (nutritional rehabilitation not withstanding).

I truly believe that this therapeutic approach is failing all of us and overall, the scientific evidence appears to support an alternative theory.

References

This link will direct you to the first page of Shan Guisinger’s findings and I greatly respect her overall opinion. The article where the information originated can be found under ‘Articles and Essays’ and is titled ‘Adapted to Flee Famine: Adding an Evolutionary Perspective on Anorexia Nervosa’.

Adapted to Flee Famine

Remembering Ancel Keys and The Minnesota Starvation Experiment

Anorexia, Self-Starvation and The Reward of Stress

Dysregulation of Brain Reward Systems in Eating Disorders