Episode 244: On this week's episode of Real Health Radio, I'm speaking with Emily Troscianko. We talk about her recovery from anorexia and then many of the topics that she has written about, like eating meat in recovery, anorexia and sex, and then research she is doing looking at reading habits and their connection with eating disorders.
Emily Troscianko is a Research Associate at TORCH, Oxford University’s interdisciplinary research centre for the humanities, as well as a writer (blogging via “A Hunger Artist”, for Psychology Today), academic writing coach, and eating-disorder recovery coach.
Her academic background is in cognitive literary studies: Her first monograph, Kafka’s Cognitive Realism (2014), explored what it means for something to be “Kafkaesque”, and she continues to investigate mental imagery and emotion in readers’ responses to narrative. She is also coauthor of the world’s leading textbook on consciousness (Consciousness: An Introduction, with Susan Blackmore).
Her research draws on personal experience, including her own illness and recovery and her work supporting others through the recovery process. Current focal points include mapping out the links between narrative reading and eating disorders, and developing behaviour-focused models of “mental” illness inspired by the theory of feedback systems.
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Chris Sandel: Welcome to Episode 244 of Real Health Radio. You can find the show notes and the links talked about as part of this episode at www.seven-health.com/244.
Before we get started, I want to mention that I’m currently taking on new clients. I specialise in helping clients overcome eating disorders, disordered eating, chronic dieting, body dissatisfaction and poor body image, exercise compulsion and overexercise, and also helping clients to regain their periods. If you want help in any of these areas or simply want support improving your relationship with food and body and exercise, then please get in contact. You can head to www.seven-health.com/help, and there you can read about how I work with clients and apply for a free initial chat. The address, again, is www.seven-health.com/help, and I’ll also include that in the show notes.
Hey, everyone. Welcome back to another episode of Real Health Radio. I’m your host, Chris Sandel. I’m a nutritionist that specialises in recovery from disordered eating and eating disorders, and really just helping anyone who has a messy relationship with food and body and exercise.
Today on the show, it’s another guest interview. My guest today is Emily Troscianko. Emily is a research associate at Torch, which is Oxford University’s Interdisciplinary Research Centre for the Humanities, as well as a writer, blogging via ‘A Hunger Artist’ for Psychology Today, academic writing coach, and an eating disorder recovery coach.
Her academic background is in cognitive literary studies. Her first monograph, ‘Kafka’s Cognitive Realism’ in 2014, explored what it meant for something to be Kafkaesque. She continues to investigate mental imagery and emotion in readers’ responses to narrative. She also co-authored the third edition of the world’s leading textbook on consciousness, called Consciousness: An Introduction, with Susan Blackmore, which was published in 2018. Her research draws on personal experience, including her own illness and recovery and her work supporting others through the recovery process. Current focal points include mapping out the links between narrative reading and eating disorders and developing behaviour-focused models of mental illness inspired by the theory of feedback systems.
I’m a huge fan of Emily’s writing. I can’t remember when I discovered her blog for Psychology Today, ‘A Hunger Artist’, but it must’ve been six or seven years ago, and it is just such a treasure trove of information. So it was a huge honour to get to speak to Emily. Because I’d been reading her stuff for so long, one conversation was never going to be enough to cover everything, and I made so many notes of ideas and thoughts and things I wanted to cover, and we got to touch on just a small fraction of it.
As part of the conversation, we talk about Emily’s experience of having an eating disorder and what her recovery journey looked like. There’s some real great reality checks as part of this, especially as she mentioned how long certain things took to change. A facet of eating disorder recovery is often this feeling of doing something wrong. This can be connected to lots of things, whether it be about food or movement or productivity. Often one of the thoughts that comes up connected to this idea of doing something wrong is “This is taking too long. I mustn’t be doing recovery right because if I was, I would be done now. This process would be over.” So it was good to hear Emily’s experience with this, because recovery definitely isn’t a quick process.
We talk about a paper that she co-authored called ‘Treating eating: A dynamical systems model of eating disorders’. We have a discussion about this based on recovery from a cognitive standpoint versus recovery from a behavioural perspective. We go through eating meat in recovery. Emily has a fantastic six-part series on this, which I’ll link to in the show notes. Emily explains her journey from being vegetarian to consuming meat again and how important this is for her recovery, and then we talk about it in terms of recovery more generally.
We talk about sex and anorexia, which is another topic Emily has written on, and finally, we go through some of the research she’s currently doing looking at reading habits and their connection with eating disorders.
I really loved this conversation. Emily is incredibly wise and well-researched, and I know you’ll get a lot out of this. At the end of the show, I have a recommendation for something to check out, but for now, here is my conversation with Emily Troscianko.
Hey, Emily. Welcome to Real Health Radio. Thanks for taking the time to chat with me today.
Emily Troscianko: Thank you, Chris. It’s a real pleasure to be here.
Chris Sandel: I’m incredibly excited to have this conversation because I think I’ve spent many, many, many hours reading your articles. I can’t remember when I first discovered you on Psychology Today. Maybe five, six years ago, sometime around that. You have such an incredible gift for writing about all different aspects of recovery, and I’ve learnt a ton from you, so thank you for that.
Today, I want to talk about some of the topics you’ve covered in your articles. I’ve tried to pick topics that I either haven’t covered in as much detail on the show before or I think could be an interesting discussion. As I said, you have such amazing content that my thinking is, for anyone who’s unfamiliar with you, my hope is that this episode is a gateway drug of sorts, and they then subsequently go and spend many hours reading your stuff. It would also be good to chat about your own experience with an eating disorder and recovery, because this has been a driving force behind what got you into writing on this topic. So that’s my hope with the episode.
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Before we get started with your eating disorder and your experience, do you want to give listeners a bio of sorts? Who you are, what you do, that kind of thing?
Emily Troscianko: Yeah, I’d be happy to, and I like the idea of providing a helpful gateway drug to people. [laughs] At the moment I have what I think is called a portfolio career. It includes offering recovery coaching to people with eating disorders. It also includes providing academic writing support to mostly graduate students at university. It includes doing writing of various kinds on topics from eating disorders, of course, via the blog, but also consciousness and things that interest me.
This portfolio came about in a rather haphazard way, I suppose. If I were to tell a brief story of how it all came together, I guess I would need to start with developing anorexia at around the mid-teens, as is so common, making some improvements with the help of a child psychiatrist in my late teens, then coming up to university here in Oxford to study French and German, relapsing pretty convincingly, then staying ill throughout my master’s and PhD, which were in German literature, and eventually, towards the end of my PhD, starting recovery properly.
Then towards the end of recovery, I started to write the blog ‘A Hunger Artist’ for Psychology Today. That gradually became one of the most important things I was doing, I realised, but I was also very aware that I was not giving it real time. It was just crowded into evenings and weekends. I wasn’t treating it as a serious professional thing. Around that time, a few years post-PhD, there was a question in my mind about, “Well, how important am I going to make this? What kind of time and energy does it deserve from me?”
Around the same time, I then also had the realisation that the stuff I was doing in my academic research, which was focused on what kind of experiences readers have when they read stories – that took in questions about mental imagery, took in questions about emotional responses – I realised that there were some links between that and the eating disorder stuff that I just hadn’t made before. It was really weird to realise how long I’d been doing this and never seen the link.
The realisation of the link came to me, as so often with reading something by the author, whom I studied for my PhD, Franz Kafka – he was a Czech German-speaking writer, one of whose short stories is called A Hunger Artist, which happens to be the name of my blog – I was reading that story for the nth time, and suddenly – it’s a story about a man, the hunger artist, who fasts for other people’s entertainment. I was reading it and suddenly realised, there’s no hunger in this story. He’s never once described as feeling any hunger at all. This seemed odd to me, but equally, interestingly, it seemed very odd that I’d never noticed this before given how many years I’d spent being hungry over almost all other things.
So I started to ask questions about, how realistic is this description of a man who fasts ultimately to death? What’s going on here in terms of the prior experiences and the assumptions that I’m coming to the text with? This seemed so relevant to all the questions I’d been asking about readers’ responses in a not-at-all eating disorder-related way prior to this. This made me think, “There’s actually something here. I would like to investigate this stuff more seriously.”
I reached out to Beat, the UK eating disorder charity, and we set up a survey study, which generated a huge amount of extremely interesting data on the relations between people’s reading habits and their mental health, with a focus on eating disorders. So that was exciting and made me realise how little is known in this area of the intersection between reading and health. That was something that I thought might become the subject of a serious, big academic grant. I was applying for permanent academic research positions at that point.
Then another lovely spanner came into the works, which was my partner being unexpectedly offered a job in Los Angeles, and us having to make some decisions about whether he would accept it and, if so, what I would do. I realised the decision there came down to the question of, do I want to keep open the possibility of being able to spend quite extended periods of time out there with him, or do I not? And if I do, I can’t have an academic job here, not a full-time one.
I decided LA wins. [laughs] I stopped applying for academic jobs of the kind that I had been applying for. I’d already had some freelance strands of stuff going on, but this obviously made there be quite an urgent need to work out how I was actually going to earn a proper living. I’d been thinking for quite a long time, should I retrain as a therapist? I’d had various ambivalence about that idea. And then at some point, I came across the concept of a recovery coach, which I’d never heard of before, and I then suddenly realised – I think it was actually Tabitha Farrar who was the first such person I came across.
I thought more and more about that, and it struck me that perhaps there is a way of being helpful to people in a way that allows for rather more flexible methods than perhaps the mainstream therapeutic protocols would do. I was fortunate enough to be in touch with a young woman who was interested in coaching-like things who agreed, very kindly, to be a sort of guinea pig. She was a wonderful guinea pig. She gave me so much helpful feedback about what in these coaching methods I was developing was working for her, what wasn’t, what she wanted more of, what she wanted less of.
And that was where it began. So now the coaching exists alongside the academic research, the academic writing support, and my own writing, and I enjoy the mixture. I think in many interesting and useful ways, the different strands intersect and inform each other.
Chris Sandel: There’s a lot there I want to go back through, but just even that final comment – have you read David Epstein’s book Range?
Emily Troscianko: I haven’t.
Chris Sandel: He talks about the benefits of having a whole range of interests and experiences, and even in a world where we optimize for someone who is very skilled at one thing, actually, being a generalist makes you better at that one thing. He references lots of different things, whether that be sport stars or people who have won the Nobel Prize for science – a high percentage of them are also artists and painters and all these different concepts. It’s a fantastic book. I am definitely of the belief that having a wide range of interests is like the sea that lifts all boats, or whatever the phrase is. I think it does really help.
Emily Troscianko: Yeah, that’s a very nice thought, and I think particularly crucial when one of your strands is eating disorder-related, because the myopia, the narrowing down of everything into a narrow focus is so characteristic of such disorders.
Chris Sandel: Yeah. For me, coaching is a big part of my day and my job and is a huge part of what I do, but I also have this podcast, I get a lot out of writing, and then if you look at the books I read across the course of a year, there’s a real mix of different things. So I’m very much of the opinion of, yes, I want to be exposing myself to all different ideas for many reasons – some because I think all these can come in and be useful for clients as well, but also for my own sanity.
Emily Troscianko: Yeah. It’s impossible to – I suppose one of the interesting differences between coaching and therapy proper, if you like, is the question of how much of yourself you’re bringing into the encounters. Not all coaches have experience of an eating disorder, but if, as I do, one does, then all those questions about how the post-recovery life is actually being lived – it’s crucial that the way it’s being lived is not eating disorder-centric in an unhealthy way.
Chris Sandel: Definitely. I don’t have a history of an eating disorder; I’m very fortunate in that I’ve had a very healthy relationship with food. There are so many aspects of my life that are relevant or are universal, so I can remember being a teenager and having horrible body insecurities and having lots of challenges there. I have, as an adult, so many challenges in life in so many different ways. I think that can be brought into it, and I’m very much – when with clients, I do talk about my own personal experiences. I think that, when done in the right way, can be very helpful.
Emily Troscianko: Yeah. Most of the people I work with have found me via my blog, which has increasingly become a very substantial way of erasing privacy boundaries that I would never, 10 years ago or so, have thought would end up being erased. I mean, I talk about such personal stuff on that blog. It’s just the complete antithesis of the therapist who tries to preserve more or less total blank slate status relative to their client or patient. Everything from bowel movements to sexual preferences, it’s all up there. [laughs] That does make for a very different starting point for coaching than if one were doing a by-the-book kind of therapeutic method in which the therapist was meant to have no personal inflection at all.
Chris Sandel: Yes, definitely. But also, there is such a great deal that you get from sharing your experience, warts and all. You get a sense of who you are, but also the messiness of life and of recovery and everything. I think so often for people, when they can read recovery stories, it can be quite sanitized or it can be very diminished in terms of the detail, where you’re covering something that’s a long stretch of time that then becomes only a handful of paragraphs or a short story. Whereas if you read all of your articles, you get a really good sense of what this is like, for better or for worse, during the process, and then how much better it is in the end even though there are all these really shitty aspects.
Emily Troscianko: Yeah, and the sanitized versions I think play rather dangerously into the idea that one should be able to predict things like length of recovery process, BMI level at which one is fully recovered, all those things that would be, in one sense, wonderfully reassuring to be told with confidence at the start of the process. And of course, which often people are told with confidence, just misplaced confidence.
Actually daring to know that you have no idea what your body weight will be at the end of this or five years after the end of this and that that is precisely the point – that you’ve been imposing all these limitations on your body, and by extension, on the rest of your life, and that lifting these limitations means not having a clue where it’s going to end up and being open to that changing everything in your life, even the things that you think you do hold most dear now, being willing to accept at least the possibility that you might not continue to value them in the same way.
All of that is, as you say, extremely messy, and it takes a long time. It’s not going to be done in a few months. It’s never quite possible to tell where recovery shades into post-recovery, but both are big and messy, as you say.
Chris Sandel: Definitely. I’m very intentional when starting with clients and even having the initial chat before someone signs up to work with me of saying, I don’t know how long this is going to take. I don’t know where your weight is going to end up. This is a lot of uncertainty with this, and I don’t want to give you false hope by telling you these things that are going to occur that I genuinely don’t know the answers to.
I also think the other thing that often people come up against is they’re like, “I thought I was meant to feel better in recovery.” I’m always like, with time that’s going to be true, but recovery is challenging, and it’s not that you start recovering and everything instantly gets better. Often many things feel like they’re getting worse. I’m in a lot of ways pretty upfront and blunt with people because I want them to know. I think it’s better them going into that knowing than, in a sense, feeling either tricked or hoodwinked or feeling like “I must be doing something wrong” because the expectation is that this is going to be this linear progression of things getting better and better.
Emily Troscianko: Yeah, as soon as you have a whole set of defaults installed, then of course it’s more comfortable to keep operating on the defaults. Operating in some different way is bound to be, well, anywhere from unpleasant to excruciating to begin with.
But I guess in a general sense, avoidance of whatever the things are – all it does, or the most fundamental thing that it does, is shrink the size of the comfort zone. If you want to start expanding that comfort zone again, by definition, yeah, there’s discomfort. There’s treading outside that boundary and it feeling probably pretty awful and terrifying and whatever else. And yet that’s the only way to get comfort to be as broad and expanded as it should be rather than narrowed down to a pinprick.
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Chris Sandel: Yeah. Let’s talk a bit more about your experience. What kicked off your eating disorder? How did you end up in that place?
Emily Troscianko: Oh, standard stuff. Feeling like I was a bit too fat when I wasn’t, and that boys would find me more attractive if I was slimmer. So that stuff going on, plus then one of the episodes that always feels like a quite obvious beginning was on a family ski holiday. The last morning, I had got pretty drunk the night before, was feeling very hungover. The others were skiing; I was sitting in the car feeling hideous. Couldn’t eat anything that morning. Then we had the horrible long drive down the hairpin bends into the valley. [laughs]
Chris Sandel: That sounds awful. [laughs]
Emily Troscianko: It was so unpleasant. Still didn’t really want to eat anything. Had a few salt and vinegar crisps or something – crisps have always been something I’ve been most able to eat when feeling nauseous, but not really eating enough to do very much good, and just realising at some point, “Ooh, this hunger feels interesting. It feels quite nice. I feel quite powerful. I feel quite disconnected from things that might otherwise bother me. I feel quite light and liberated in some way.”
So yeah, that was my first experience of the hunger high, I suppose. It got pretty addictive. Did then the standard things of starting to cut out meals and all that. Of course, the hunger high didn’t actually last very long. It kept coming for maybe a few months, but as with any addictive high, the more you chase it, the more you habituate and the less reliably it comes. Certainly the falling off from getting that and finding it amazing to just having gnawing, chronic hunger that was deeply unpleasant was pretty quick.
Chris Sandel: When that disappeared and it was just gnawing, chronic hunger, was that your moment of noticing “this is a problem”? Or when did it dawn on you “this is an issue” even if you weren’t able at that stage to make any steps towards recovery?
Emily Troscianko: I’m not quite sure when I realised that it was an actual problem. I suppose because there wasn’t a light bulb moment, as with all of these things. It was partly about other people getting worried, and actually a kind of symmetry, I suppose; at the end, when I finally did embark on my final and successful recovery effort, it was also in large part driven by other people’s worries and perspectives.
So I suppose it was partly I went on a long train journey around Europe trip after my GCSE exams, the exams we do at age 16 here in the UK, and I came back from that month looking so much visibly thinner than I had looked when I left that I think that was the point at least at which my parents finally realised something was wrong. Once your parents get scared, then it’s natural for you to as well. So I think that was the time when I stopped being able to completely kid myself that this was all under control.
And then I suppose – again, as so often – it was really the experience of trying to do something about it and realising how hard that was that made it totally clear, “Okay, maybe I’m not in control here, because if I were, then just eating these boiled eggs and soldiers wouldn’t feel this feverishly difficult. It would just be something I was doing because how I’d been eating before wasn’t working for me.” So I think the combination of other people getting really scared and me realising the solutions weren’t coming easily to me – that was probably what made me understand.
Chris Sandel: I think that’s a good litmus test, the psychological flexibility piece. I think often it’s easy to say “But I do want to keep up the exercise” or “I do like this way of eating” or whatever, but it’s like, okay, let’s try and do something different and see how able you are to do it. Even though you think you like this thing, if you try and do something different and there’s a real inability to do so, that’s fairly telling in and of itself.
Emily Troscianko: Yeah. I like to think of a person whom everyone misunderstands. There’s a young woman or man who’s doing all this stuff that other people object to – not eating enough, exercising too much, whatever the things are – and these concerned people give her a whole list of things that they think she should be doing differently and that would make her life much better if she did.
There are two options. Either she goes ahead and does all those things and it means nothing to her because she’s genuinely chosen her own way of doing things; she doesn’t particularly think the other ways sound great, but she’s willing to give them a try because she’s chosen her stuff and is open to plausible alternatives. She tries it all, it doesn’t work for her or it does and then she changes, whatever.
Or there’s the person who looks at that list of recommendations from the other people and thinks, “What the fuck? Of course I can’t do that. Of course I won’t. Of course this would be an existential challenge to me. Of course you’re wrong” and gets terrified by just the prospect of even making one micro-change, let alone doing this whole huge list. Just that kind of thought experiment I think can be quite revealing of, could you just go and do the stuff and show that you didn’t care? Probably not.
Chris Sandel: Yeah. The second category there is typically where clients find themselves when I’m working with them, at least in the beginning, where it feels so monumental to just think of changing this one thing or to start eating an hour earlier or whatever. That hits them to the core, and as you say, that can be quite telling of how much an impact this is having.
Emily Troscianko: Yeah, and one of the most crucial and interesting questions right at the beginning there is where to intervene. You’ve got to get that at least decently right, and I suppose it’s always a balance between where it’s going to make the most impact to intervene so that you’re not wasting energy fiddling around at some edge case that makes no difference to anything else, but also balancing that with where it’s feasible to intervene. “What can I actually change tomorrow?” and striking the right trade-off there between, if you like, how optimal and how feasible it is. That’s one of the key questions in a behaviour-focused model of recovery, which I tend to adopt.
Chris Sandel: That part I definitely want to go into, because you’ve got a great paper that you’ve written on this.
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But before that, what did your recovery look like? Was it a behaviour-focused recovery? Was it on your own? What did it look like?
Emily Troscianko: It was structured by CBT-E, the eating disorder-specific version of CBT. I went for a preliminary assessment at the clinic here in Oxford and was told my BMI was too low to be admitted onto the outpatient programme. I was given the option of inpatient but absolutely detested that idea. I dithered around for a while, took some Prozac, which I think was a bit helpful – maybe only placebo effect, but it certainly seemed to loosen something up cognitively – and then went back for a second chat.
Basically, an ultimatum was set, which was “You’ve got six weeks to gain” – I think it was a couple of kilos, maybe three. So it was just about doable within the timeframe they set out. They said, “If you introduce 500 calories extra per day and stick to that completely consistently, you should gain half a kilo a week, so it should be just in time. And if you can get your BMI up to this level, you can start the nine-month treatment programme.” It was part of a clinical trial testing normal CBT against CBT-E.
I don’t think that the woman had any real belief that I would do this. [laughs] I mean, I’m sure she said the same thing to many people, and I’m sure most of them did nothing. And it was definitely on a knife’s edge whether I was going to do anything. I had, that evening, a long conversation over quite a bit of wine with a friend – one of the only friends I had left at that point – going through the pros and cons of, “Should I do this? Am I going to do this? What will it mean to do this?”
We worked out that it meant I would start eating breakfast tomorrow morning. I normally didn’t wake up until lunchtime or even later because I was delaying food until late into the night and so on, but I would eat breakfast as soon as I woke up – which was not early – and have a supposedly afternoon snack at evening time or whenever it was, and that those two things together would make up 500 calories. So that was the decision to be made: am I going to actually do that tomorrow?
I wonder what would’ve happened if on that evening I’d just bailed out and said, “No, I can’t do it.” These turning points are so strange to look back at. I’m very grateful that he was there. I’m extremely grateful that he did some wonderfully practical things like going to the supermarket with me, helping me decide what this breakfast and afternoon tea thing were going to consist of, actually spending the money and buying the things for me because I couldn’t bring myself to do that. If he hadn’t been willing to do all that, then I don’t know what would’ve happened. Probably nothing for who knows how many more months or years.
So breakfast happened the next morning, and it tasted amazing. It was so rapidly such a relief to know – I mean, who’d have thought it? If you go to bed in the evening knowing that you’re allowed, as the first thing that you do the next morning, to eat something, instead of having to count however many hours of doing tiring things until you can possibly eat anything – gosh, how surprising that that could actually make you feel better. [laughs]
In that sense, some of the initial changes were actually pretty quickly self-perpetuating. Despite what you said, and it’s sadly true, that recovery includes some awful bits, I did actually find there was a delight in eating more. And there should be. There is if you take away some of the complicated layers. You’re just a starving organism. Starving, suffering in all these ways thanks to lack of fuel. You give it some more fuel and yeah, the organism can respond. I really felt that quite powerfully in those early days – that a response was already kicking in, that something was building.
I went to an academic conference like a week in, and the fact of actually being able to get lunch with people felt miraculous and like a wonderful professional enrichment as well. There were lots of things in those early days that gave some nice encouragements along the way. I managed to just scrape in above the required BMI threshold and got admitted onto the CBT-E trial.
The next nine months were extremely helpful in the sense of having a guide through what to expect in this process, how to get over the hurdles of having made a certain number of changes but really not wanting to make any more. I remember breakfast remaining an issue for such a long time. I kept wanting to have more of a delay between waking up and first eating. To have someone there who was willing to do a bit of challenging of that and come up with experiments for me to try and all that was so useful.
A less helpful part of the therapy was being told, “Okay, now you can do maintenance.” I thought she knew what she was talking about; I think this was about six, seven months after I’d started eating more, or four or five months after starting the therapy, and she gave me advice about how to maybe reduce my portion sizes a bit, how to switch whole milk to semi-skimmed, all that kind of thing. I did start doing that, and I just thought, “What on earth am I doing? How is this ever going to lead anywhere other than back where I started? I can’t do this, and I don’t want to.” So my maintenance phase turned into gaining another 10 kilos or so. [laughs]
Chris Sandel: Which is awesome, though, that you were able to have that presence of mind to know, “This isn’t the right thing to do, and I instinctively know this.” And even though the eating disorder thoughts may have come up and started to be louder again and all that, for you to be able to push through that and say, “No, I’m going to do this a different way” is incredible.
Emily Troscianko: Yeah, and I don’t know quite what allowed me to. I think it was partly just how quickly the old habits kicked back in. Once you start saying, “Now I shouldn’t probably have dessert today, should I?” and choosing your milk on the basis of fat content or something – it was all, one, so obviously logically counterproductive, but also did start up those little trains of calculating type thoughts so quickly that I could just see it was going to be an undoing of the past six months. It was stupid.
I never really told her that explicitly; I just kept doing what I was doing, and she kept observing that weight was going up. I guess she also observed that I wasn’t freaked out by it, and I suppose she expected me to, and that’s one of the reasons why these recommendations are made. They think you won’t cope. And if you do, well, that’s fine. Their job is made easier and they can just watch you carry on growing and watch your life carry on expanding in the ways mine was.
So yeah, by the time we had our final session – we’d had a few follow-ups, so I think this was 11-12 months in – I was near the top end of the supposedly healthy range. I don’t remember whether we had discussions about what the weight was at that point, but I think we both knew it was good. The weight gain didn’t stop there; I carried on gaining weight into the officially overweight territory. I think it plateaued around 15-16 months after the start of the whole process.
Coming back to long and messy, yeah, it was long. [laughs] And then what happened there – well, I finally realised, “I’m just getting hungry like normal people, like I used to. I’m getting hungry for meals, and now I’m eating them, and now I’m feeling full” instead of “I’m getting hungry, I’m eating, I’m really full, but I’ve still got this underlayer of hunger underneath.” I never really believed that that would go away, I suppose. I thought there would always have to be a desire to keep eating no matter how much I’d already eaten.
But at some point – and again, it’s not a flash of divine blessing and you suddenly realise “I no longer feel that underlay”, but I suppose I realised, “For a few weeks now, that hasn’t been there.” Around that point, that was stabilisation. That was the thing that needed to happen. Gosh, if I imagine having stopped at BMI 20 and none of the rest of those many months of eating a hell of a lot and doing all the things that eating a lot allowed me to do, of course I’d have just been another one of those statistics of people who get to remission and then relapse and never get out.
Chris Sandel: Yeah, and I think the problem as well with that is because you’d been told that this is the right place for where you need to now do maintenance, you then realise, “I still have all these thoughts, I still have all these anxieties”, and you think these will never go away. It then becomes easy to think, “If this stuff’s never going to go away, why not be at the lower weight anyway? I’m never getting to the place I thought I could possibly get to or people have told me is what could potentially happen, so if I’m going to stay in this quasi place, why not reap the benefits of at least having the smaller body?” I think that’s what happens for so many people; they don’t get to a place far enough in recovery to realise what is actually on the menu and what is available if they can just keep going.
Emily Troscianko: Yeah. Life has such a vast menu, and being pseudo-recovered cuts you off from so many pages in that menu. It also keeps looking like it’s in bold print and surrounded by all kinds of highlights. The body shape, size, weight item on the menu as well, all the evidence about how over-salience of body appearance does dwindle as your body, ironically, gets bigger and better fed – all that stuff is so difficult to believe because, as you say, you’re trying to make that trade-off and get the slimness along with the moderate amount of freedom.
But yeah, that thing you’re trying to optimise for is not going to matter to you once you’ve refused to optimise for it enough that you can get the other stuff that you will genuinely be enriched by the rest of your life.
Chris Sandel: Totally. And I can also get why it’s so challenging to get to that place, because 15 months is a fucking long time for you to keep having that gnawing sense of hunger, even after you’re full, and to think “Maybe tomorrow that’s going to go away.” It is a long time to have to wait for that.
And it’s n=1, so your experience isn’t what’s going to happen with everyone else, but I also think it’s useful for people to hear this as well because so often there’s the thought of “I’ve been doing this for three months or six months; why hasn’t it gone away?” For you to say it took 15 months for that to happen – and that doesn’t mean that is even the longest amount of time for that to occur. But at least it gives someone a bit of an idea of this can and probably will go on much longer than just a couple of months.
Emily Troscianko: Yeah, and that ties into the importance – which is probably one of the main roles that I see myself playing as a recovery coach – helping clients remember the importance of speed in all of this. It’s such an easy default to think, “I’ll take it safe and slow. I won’t push it too much and take it gradually.” It’s the opposite of safe because it almost always ends up in stasis. It tends to result in doing lots of effortful attempts at change, but not in a decisive enough way that any benefits really result from that.
And if you’re not getting any benefits, of course you don’t care on doing these horrible things, so you just subside into nothing much changing. So I think a bit of terrifying “get the hell on with it” speed is crucial there, because otherwise the 15 months are going to, in theory, turn into 30 months instead, but actually in reality grind to a halt at some point because it’s all too depressing and difficult and lacking in payoffs.
I think acknowledging the length but also not allowing it to become unnecessarily protracted is important. I was just thinking about – you said n=1, and absolutely this experience has nothing necessarily generalizable about it, but also, yeah, 15 months is a really long time to be going against so many of the social pressures that are saying “don’t eat this way.” That’s one of the very most exhausting things in a recovery process from a restrictive eating disorder, and other types, that all involve prioritising eating generously. That principle of eating generously in a way that supports the kind of life you want to have is not, sadly, the one that we’re taught to live by.
So yeah, it’s exhausting to be going against all of that for so long until you have reached the point of equilibrium where you’re confident that you’ve worked out for yourself the way of eating that really works for you. When it’s still in process, it’s so easy to get thrown off course by all the other examples of slightly shitty ways of doing things.
Chris Sandel: Definitely. And I do think that that idea of going against the norm of what society’s recommending is more salient to you when you’re in the place of the eating disorder and is less salient to you once you get out of that place. What I often talk about with clients is there’s lots of ways in their life that they are bucking social norms that they genuinely don’t care about, and then there are ways they do care about. So it’s not that the social norms and the social pressure doesn’t matter, but I think it matters less, and how you think about that is the thing that has a really big impact.
One of the things I like in your writing when you talk about really getting over an eating disorder is going in the opposite direction for so many of these things that challenge you. If you’ve had issues around being frugal, go and spend a ton of money. If you’ve had issues around “I want to be really safe”, do things that genuinely feel slightly dangerous and challenge you. Really push against that to then eventually find where that balance or equilibrium point is.
But I do think that a lot of the time what is talked about as “the problems that are being put upon me by other people” are only cared about because actually, you’re the one that genuinely cares about them.
Emily Troscianko: Yeah, that’s a nice way of thinking about it. Useful to be reminded, I think for all of us, that we happily rebel in all kinds of other areas, and if this is anomalous, then that’s worth looking more closely at and asking, “Why should I capitulate to these sociocultural pressures in this area and not in all the other things that I care about?”
I think a really striking central part of my post-recovered life has been a real enjoyment in just building everyday habits from the ground up, working out what first-thing-in-the-morning routines are really good for me, what make me want to get up, what give me the important things at the start of my day that I really care about and am made happy by having in there.
Once recovery has become an example for you about how you do have to do this life construction for yourself, and that if you don’t do it for yourself, the defaults that trickle down from wherever the hell they trickle down from are probably not going to be working very well for you – it becomes a really nice, very constructive and rewarding way to go about all kinds of things. Just ask the question, “What would work well here?” and then give it a try. And maybe that doesn’t actually work well, but you try some second and third thing that work better.
There’s such a power in that, as I say, recovery can be a first initiation into, because you can’t accept either your own former defaults or the social ones. So you’ve got to start again, and it starts with “What way of eating works best for me?” That won’t be the same in early recovery or mid or late or afterwards, but each iteration will build on the last. And then it can expand out to all the rest and, despite all the constraints that the real world imposes, of course, you can end up really creating a life that works for you.
In that sense, there’s something to be said in a positive sense for having had a disorder like this and having got over it. The getting over is the start, in the best case, of that lovely habit of not taking things for granted, performing experiments, seeing what changes, and keeping the good stuff.
Chris Sandel: Definitely, and I do think the longer term aspects of recovery is that journey back to oneself and really understanding, as you say, “What genuinely works for me? How do I genuinely want to spend my time? Who are the people I want to be spending that time with? Because for so long, that completely got hijacked, and it felt like “This is how I want to be doing things”, but that wasn’t, in its true sense, how you did want to be spending your time or what was best for you.
So yeah, I’m very much of the opinion of helping clients to see the eating disorder with time, and the recovery process especially, this can be seen as a beneficial thing – and not in a sense of returning to it, but of like this is the thing that helped you start to figure out, “Who do I want to be and how do I want to spend my very limited time on this planet?”
Emily Troscianko: Yeah, remembering the brevity of a human life is often extremely useful.
00:51:31
Chris Sandel: I want to talk about a paper that you’ve written that you did with Michael Leon called ‘Treating eating: A dynamical systems model of eating disorders’. It’s a paper I read fairly recently, so I think it would be useful to go through this. What were your reasons for writing this paper?
Emily Troscianko: I’d never written a formal academic paper just about eating disorders before. I’d published the write-up of the study that I did with Beat. In fact, published two papers from that, one in the Journal of Eating Disorders, which was a write-up of the experiment and results proper, and then a more speculative or theoretical piece for Medical Humanities about why we should be investigating the interactions between narrative reading and mental health more. So those were the closest I’d got, but all of the other eating disorder writing that I’d done was via the blog.
It was a sense of wanting to crystallize in a rather more formal sense a lot of the thinking I’d been doing about what eating disorders are and how to help people recover from them properly. That was one of the broad motivations for doing this.
And then the way it came about was that Michael wrote to me having stumbled across my blog. I think he was googling the Minnesota study and found my take on it and thought that was nice and got in touch. He is a collaborator with the Mando Team, who are based in Stockholm. Their treatment method is a very decisively behaviourist approach to eating disorder treatment.
They’ve developed a device called the Mandometer, which essentially is an app on your phone and a weighing scale underneath your plate, and the idea is that as you’re eating, you observe on the screen a normal curve for eating rate, so speed of eating the meal, and you try to match your eating speed to the normal curve. You see where you’re starting to deviate from it and you can bring it back. There’s also a second curve which tracks increasing fullness over the course of the meal. You rate your own fullness and you see who that may diverge radically at the beginning, but the idea is that also starts to converge with the normal curve in time. So an extremely, as I say, behaviourist approach to what it means to help someone relearn how to eat.
Their success rates are impressive. They get about 70% of people to fully recovered, including a five-year follow-up period, which is almost unprecedented in the clinical literature. The chance later to travel to Sweden and meet with Per and Cecilia, who are the co-founders of this clinic, was also really eye-opening for me.
So we started hatching a plan for writing some kind of piece that drew on the Mando methods but also went broader than that, partly because strategically, diplomatically speaking, the Mando guys have not been well-received by the eating disorder clinical mainstream. Partly that’s because they’re not always the best at being diplomatic. [laughs] Partly it’s also because there are a lot of vested interests which they’re acting against.
It was always going to be risky to include their stuff in an academic paper anyway, but the more I thought about it and the more we talked about it, the more it really did seem to make sense in a much broader and theoretically robust way. The whole behaviour thing.
Our basic argument is that eating disorders are disorders of eating – that we’ve got to take the eating behaviour seriously if we’re going to sort anything. We suggest that yes, of course, the psychological stuff and the physiological stuff is important, but that if you’re thinking about where to intervene, where to try and make the change that will have knock-on changes that will result in a successful progression towards not having an eating disorder, then the behaviour is almost always the place to intervene.
If one understands an eating disorder as an unstable feedback system, then what successful treatment is doing is stabilising the feedback, and that, we argue, tends to start with identifying, as we talked about earlier, where’s the right place to intervene? Where’s it most feasible and most useful to intervene? That’s almost always, in the case of a restrictive eating disorder, with an intervention to sort out the malnutrition.
So the question there becomes shifted away from the question of “What’s the ultimate origin of this disorder and where can we trace back its aetiology, its ultimate beginnings?” to “What’s sustaining the current feedback dynamics right now? How is the problem actually being maintained in the present and how can it be changed in the future?” So that’s obviously quite a radical departure from the standard psychotherapeutic model of digging into the origin stories.
It’s also somewhat different to the realities of how cognitive behavioural therapy is practiced, even though that is the method that’s most explicitly based on feedback principles nowadays, and we suggest some reasons why, despite having got the thing right as regards the importance of feedback, CBT is not necessarily living up to its potential. But that’s the basic idea in the paper: to say mind, body, behaviour, all interlinked in feedback dynamics; if you want to intervene effectively, do it with the behaviours.
00:58:10
Chris Sandel: It was interesting when I read through the paper; you in a sense compared the Mando method with CBT, and I think you also allude to this in the paper as well: CBT can be practiced in so many different ways, where there is much more of a behaviour focus.
I had Dr Lauren Muhlheim on the show. For listeners, it’s Episode 232. She is a huge advocate of CBT, but when we talked about it, it was very much focused on the behaviour piece. She talked about it’s not important to go into where all this started. It can be helpful to explore that as part of learning the person and everything, but in terms of actually making a dent in the eating disorders, it is about, how do we focus on making a chance with your eating, getting you to eat more, getting you to keep a food log? All of these things in terms of changing behaviour in service of recovery.
But I also know from other clients that I’ve worked with where they talk to me about “I worked previously with this therapist who was doing CBT with eating disorders”, this was not their focus. So the ‘B’ in CBT seems to have more or less of an impact or more or less of a focus depending on who is using that method.
Emily Troscianko: Yeah, and it’s important to remember that CBT was developed in reaction against the overly psychologized methods, psychoanalytically-inspired methods, for example, or psychoanalysis proper. It was radical in the sense of bringing behaviour into things at all after behaviour had become a dirty word since the excesses of behaviourism. There’s so many complicated 20th-century currents of competing intellectual agendas that have fed into this.
Chris Sandel: Skinner ruined behaviour modification.
Emily Troscianko: Exactly. [laughs] But then we find ourselves drifting back in that direction in many important ways. So there are absolutely great examples of CBT done with, if you like, equal weighting or appropriate weightings being given to the ‘C’ and the ‘B’. But I would say there’s quite a bit of evidence of gradual drift away from ‘B’ and towards ‘C’.
We suggest some reasons in the paper for that. One of them is just it can be way more interesting. You get to do the storytelling thing that humans love. You get to listen to someone else’s stories about their childhood and their relationships and their worries about control and about all these thorny existential matters. How much more interesting to do that than to talk about how much you should have for breakfast. So that’s one reason there might be that drift. There are doubtless many others.
Partly I think there’s a desire to manage anxiety, to not inflict, for example, excess anxiety on a patient and have the misguided sense that the right way to go with that is to essentially do avoidance. As we talked about earlier, the only reliable effect of carrying on avoiding things is to just keep ramping up the anxiety, so it doesn’t work. But if the patient really doesn’t want to do the food diaries or the regular weighing or whatever, there can be, I think, an illusion that you’re doing benefit to the therapeutic alliance and therefore also to the recovery process by colluding in that desire not to do those things.
So yeah, there’s lots of stuff going on, and CBT can work brilliantly when it’s not shackled to too many of those problems. Other problems include what we’ve touched on already, which is the overvaluation of body weight normalisation above all other things, the implausibly low body weight thresholds that are considered to be acceptable markers of recovery success and all that stuff. That’s pragmatically driven, often, by the need to demonstrate certain success percentages and all that stuff.
In essence, there’s a whole lot of stuff that CBT is getting right. I guess theoretically, one of the things I think maybe where there’s some fundamental confusion is, again, in relation to these feedback dynamics. You’ll often hear the phrase ‘overvaluation of shape and weight and their control’ in the CBT eating disorder literature, and I think there’s often a bit of a confusion about whether that was the starting point – so in a temporal sense, this is what long ago got the thing started – or whether that’s now, if you like, the controller of the feedback system, the thing that’s doing the maintaining of the dynamics now.
I think assuming that it is – this very cognitive aspect of overvaluation, assuming that that’s the controller, or assuming that body weight is in distinction from behaviours, I think that tends to result in some of the less helpful procedures associated with CBT. They’ve got all the feedback diagrams and everything, but they’re still assuming that the overvaluation in a cognitive sense has this intrinsic priority over the rest, where that may not actually be the case.
Chris Sandel: And as you talked about with your own recovery, the more overvaluing starts to disappear and then disintegrate, the more you are well fed and the more recovery repair has happened, etc. So even if it is incredibly salient and it feels like it is the driver, it’s actually a symptom of other things that are going on that will have an indirect way of changing that.
Emily Troscianko: Yeah, and that switches the whole usual way of thinking about cause and effect and underlying root causes versus symptoms on its head, because instead of that being the origin and the behaviours and the physical state being the effects, the symptoms, it’s the other way around. And there’s not much evidence for that. The Minnesota experiment is of course a seminal example of really potent evidence for that switch of perspective.
There’s just so much evidence that looking for those root causes and thinking that they lie in the psychology is just mistaken. You can waste so many years by trying to do the intellectual unpicking, and it can feel delightfully satisfying and rewarding in that intellectual and maybe emotional sense, but I always find it so upsetting to read of actual therapists doing work with actual people who are starving, and they don’t even talk about the eating, let alone do anything about it. It seems incredible to me.
So if you want to change the vicious circles that wrap themselves around you so tight when you’re descending into illness, if you want that, in technical terms, positive feedback loop to be switched for a better one and then ultimately into negative feedback, so stabilisation, then you’ve got to start somewhere where the dynamics are really being driven from. And it’s not there.
Chris Sandel: I completely agree. I want to touch on some of the other articles that you’ve written, and I already know that I’m not going to get through all of the stuff I hoped to, but I’m going to pick a couple of things you’ve written and we can talk a little about them.
01:06:32
You’ve got a six-part series on eating meat in recovery, and this is something I’ve shared with numerous clients at different points. I think it would be useful to talk about this. We can start with your personal experience with this and then we can go through some of the other aspects that you touch on throughout this series.
Emily Troscianko: My personal experience was that I watched some kind of video of chickens in battery cages when I was about 10, found it very upsetting, decided to stop eating meat. My mother was already largely vegetarian; my father was accommodating, so I was happily mostly vegetarian for some years after that.
Then with the start of my anorexia, not eating a whole big food group like that was very convenient, and I just became more and more separated from the idea that eating meat could ever be a possibility, I suppose. Occasionally I would catch a bit of smell of some frying sausages or something, or barbecues, things like that, and have a bit of a sense of longing. But as with all longings for any kind of food, I would just set them aside.
So meat wasn’t really on my radar at all until at some point in the year when I would, later in the year, start recovery, I just realised that I had – maybe it was, again, smelling of barbecue or something – but realised that I had a huge desire to eat some kind of animal product. I mean, I was eating a little bit of yogurt and milk, but nothing much else. I asked my mother, “Would you be willing to get some steak and I could have a little bit?” She said yes, and I had a bit of hers, and it was incredible. In particular, the fat around the edge of the meat – I think it was a ribeye or something and she’d done the rendering of the fat really nicely and it was all crispy and melty and just wonderful. I just felt like I could keep on eating that forever. I didn’t; I just had a couple of bites or whatever and stopped there.
But I came back to that experience so many times in early recovery. I realised that I wanted and needed an awful lot of meat, and for the first – probably for five-ish years of recovery and then afterwards, I ate a hell of a lot. It became even a running joke at work that I was the person who, if there were leftovers at the dinner or whatever, I would always be after them first. When we went away on this work retreat, I was the one who was given responsibility for cooking the steaks and doing all that. It was just part of what Emily’s like. A standard breakfast would be like six chipolatas and loads of scrambled egg and stuff.
I just had a huge appetite for it, and there was nothing else that – in the absence of that, I couldn’t really get properly full, coming back to that question that was so important at the end of recovery proper. So yeah, I let myself do that.
Of course, I had ethical qualms about it. There are so many things wrong with how animals are bred and killed for meat that it would be crazy not to have ambivalence about eating meat. But I bought the most expensive meat that I could, and I also tried to remind myself of the importance of getting myself well and letting myself stay well.
Eventually, I think five or six years after the whole thing had started, I gradually realised, “Okay, I don’t need to be eating quite this much anymore. I don’t want it as much as I used to.” I started switching in some more meat substitutes and gradually the chipolatas at breakfast became haloumi or something instead and it all got a bit more moderate. But as with many things in this process, it was, for me, extremely important to allow those appetites to be immoderate and to honour them and to let them come to their own stabilisation rather than rejecting their validity from the outset.
Chris Sandel: It’s an interesting one because I think this has in some ways got more complicated now because we’re at a place where there is much more of a push for plant-based, there are all these different alternatives. I imagine it’s not that being vegetarian or vegan 10 years ago was something strange, but it feels different to how it currently is for someone to say, “I’m vegan or vegetarian.”
Emily Troscianko: Yeah, absolutely. There are, as I said, very good not only animal welfare-related reasons to eat less meat but also extremely important climate change-related ones and sustainability-related factors and all kinds of other senses.
But one of the important questions to ask here, I think, is: Is this why you’re doing it? Do you really care about the planet / the animal that much, or are they a cover for the things you’re scared to do or resist the idea of doing for other reasons? Again, coming back to that little thought experiment of the woman who does the things to show that she can do them and it doesn’t mean much to her, and that she doesn’t overestimate the importance of any single trivial human act.
Just do the thing and see how it feels. See what happens. Maybe it doesn’t do you any good, maybe it does, but if you refuse even to take that basic step in developing more self-knowledge, which is just have the burger – stop building that up into “now the climate catastrophe is all on me.” The world can suck up your experiment. You’re not that important.
And of course, you always have to balance that with change only happens as an accumulation of individuals making different decisions, but in the end, what are you pitting against what here? If this could be the difference between you finding a way out of this disorder – which, by the way, is massively resource-intensive in all kinds of ways, whether it’s directly through the demands you put on, for example, a health care service, or whether it’s just in how it affects the lives of people around you and has all those ripple effects. Beyond resources, of course, is the diminishing of the sphere of human existence which you’re involved in.
Again, do the trade-off. Work out what really matters here. And I suppose I would also say, appreciate just how much any recovery process from this type of illness hangs in the balance. It is so much not guaranteed that you will get to the end of this. It is so important to treat every opportunity to do something that increases the odds of that happening really seriously and realise that if you reject 9 out of 10 options that might just make a difference, it’s probably not going to happen.
There’s a fine line between depressing people by making it sound impossible and helping people have the realism that accepts that relapse and chronic partial recovery are extremely common, and if you want that to not be you, you’ve got to take some actually bloody radical action. And that might mean going against everything that you hold dear just to see what happens. If you’re not willing to do that and you put up barriers at every turn, yeah, you’re going to have a much harder battle on your hands, and you may not win it.
01:15:20
Chris Sandel: Definitely. A couple of things you said as part of the article – with time, as you explained there, you started eating less meat again. So in a sense, you have earned the right to be more conscious of this thing because you’re in a better physiological state. You don’t have the importance of having meat in the same way as it was at one point in your life.
You also talk about you then have the energy to go and do other things in the world that could make more of a difference. So by just saying “Cool, I’m not going to eat steak or sausages or whatever it is”, by getting to a place of being healthier, if you then choose to, you can go and make a much bigger dent in the world in all of these different ways than by staying ill and not eating the meat.
The other one that comes up a lot – and I think I was first exposed to this idea through Gwyneth Olwyn, but I think it’s true – there are so many ways in every aspect of your life that harms are accruing that you don’t even pay attention to. If you’re using an iPhone, if you’re using a Mac, if you wear Nike trainers, if you shop at Topshop – basically, if you do all the things that most people do, there is huge amounts of human suffering occurring somewhere because of that. And it can be even the basic stuff of just buying batteries or whatever it may be.
For all of those things, there’s generally not a second thought given, and there is then huge amounts of thought given to this one particular thing that is having a massive impact on your ability to recover. So I think the reframing of looking at all the other areas where there are blind spots, where damage is occurring that is just ignored because it’s not as salient as the meat issue.
Emily Troscianko: Yeah, or else it all becomes ultra-salient, and then you get even more paralysed by incapacity to do anything. I was reading a New York Times piece the other day about how climate change is entering the therapy room or something, about how absolutely justifiable climate anxieties are becoming therapeutically significant. I’ve certainly observed that in some of my clients; the over-salience given to food-related decisions is now expanding into the question of, what kind of battery are you buying? All the other ways in which human existence does involve destruction and the infliction of suffering on other humans, on other animals, on the ecosystem at large.
So yeah, either you can go down the path of trying to minimise, as you put it, the dents that you make on the world at all costs – you can consume less in all the ways, you can try and make your priority “do less harm”, I suppose – but as you say, that doesn’t work. How are you meant to – the rawest veg vegan diet, the crop planting is wrecking the ecosystem that was there before. The transport to you. Yeah, you can try and become self-sustaining in your own garden, but that’s pretty damn hard. All the ways that any organism survives depend on consuming other organisms in some way.
So the alternative to that is then to say, sure, the dent I make in the world in terms of the damage that my survival inflicts on other parts of the world is not ever going to be zero – not very close to zero, either – if I decide that I also want to try and maximise the positive dent that I’m making in the world in some interesting ways, and to recognise that I need to be fuelled appropriately and to have some number of the other supports for having a rich and empowered life that may be relevant.
Instead of just trying to minimise my impact on the world because impact is bad, think about what the good impacts would be. An example I gave in that blog series was a client who was studying to become a vet and was very vehemently vegan. I always had the thought, observing how ill she was and how narrow her mind and life were and how, yeah, she was just about managing to hold down an internship at a vet but would probably never manage to do more than cling on in such a job – if she made the decision that really put recovery at the top, which I gradually got the sense would be daring to at least put the veganism on hold – that’s a whole other several steps beyond vegetarianism – if she’d done that, and maybe she still will, what things could she achieve in the realm of animal welfare, of improved living conditions and slaughter protocols for animals and improved awareness about what a difference this makes and improved policymaking? Goodness knows what she could go on to do if she just were not ill any longer.
Chris Sandel: I totally agree. Part of the reason I wanted to talk about this today as well was because I’ve had a client who recently – I can’t remember how many months ago she started eating meat again, but she’d been a long time vegan or vegetarian, had been doing that I think since her teenage years. It was very much part of her identity. This was one of the latter things we were able to work on. She started to eat more and a lot more, and it made lots of improvements.
But this was one of those things that was still hanging around, and she has now changed that and she is eating meat, and it has made such a difference in so many aspects of her life. It was interesting to see someone who it was such a big part of their identity and how much, in a very short space of time, that shifted once meat started to come in, and how much she was then able to grasp and notice the difference this was making. Where before, even if she could intellectually understand it, she just didn’t have the visceral experience of how much of a difference this would make.
Emily Troscianko: Yeah, it’s so hard to really imagine in advance. I suppose because it’s convenient to us to think of ourselves as more than just boring old animals who are the sum totals of all the cells that make us up, and that the cells are driven by the biochemistry and that there’s nothing more to it than that. Because it’s nice to think of ourselves as something else. It is very unnatural to imagine that just something as basic and prosaic as whether or not you eat some bacon could change so much about your life priorities, your value system, your way of interacting with other human beings. But it’s kind of beautiful.
And coming back to the storytelling about childhood origins as more intellectually interesting, I think really the intellectual and certainly the emotional interest is far greater this way. I mean, what a miracle that the fact of choosing the whole milk or choosing the ribeye steak or whatever it might be can initiate or be part of the initiation of these cascades of beautiful transformation that may lead you to become a quite different person than you ever thought you could be, let alone wanted to be.
It’s so magical to watch that happen. It’s been magical to watch it in myself, but also to observe it and sometimes help it happen in other people when we release ourselves from these straitjackets.
Chris Sandel: I totally, totally agree.
01:24:18
There’s another article I want to go through. I know you started this conversation saying that you reveal a lot about yourself as part of the blog, and you’ve got an article on the complicated relationships between anorexia and sex. I want to talk about this just because it’s not really a topic I’ve covered in any real detail on the podcast. It would be good – again, you can talk about your own experience with this, but then we can talk about some of the findings or the research you looked at as part of this article.
Emily Troscianko: My own experience with sex and anorexia was, I suppose, basically, that they’re not very compatible. [laughs] I think that’s generally pretty universally true, with probably some exceptions.
Starvation is a brilliant way of making sexual drive and capacity switch off. I don’t know whether it’s fortunate that I had quite a bit of sexual experience before I got ill, which made it probably less difficult to dive back in during and after recovery. But for many people that isn’t the case, so there’s a whole bunch of sexual learning and exploration that are fully deferred until whenever recovery starts to happen.
But I think it’s a really interesting example, again, of what we were just talking about: the intimate links between these profoundly physical – I mean, what could be more physically animal-like than orgasm, for example? The links between that and everything else that’s going on, all the control questions, the intimacy questions, what it means to open yourself up to an experience of this intensity. All that stuff is swirling around here. It’s one of those places where it’s a beautiful little microcosm of how you see whether stuff is working in any recovery process.
Not that anyone needs to go and have loads of sex or any particular kind of sex or whatever, but just that this is another little litmus for how much stuff is still messed up and how much stuff is gradually sorting itself in a very biologically predictable way. Again, not making ourselves out to be too special here. It’s just a pretty typical thing that stops working when you’re not looking after yourself, starts working again when you are.
Chris Sandel: You talked about your experience being somewhat atypical in that you had had lots of sex before developing your eating disorder. It was interesting because it wasn’t just the sex; it was you’d had experiences with drug-taking and going clubbing, and then when the disorder took hold, it almost is like there was this dichotomy between old Emily and new Emily. I wonder, when you were in the disorder, did it feel like “I feel good that I’ve shed old Emily”? Like old Emily was up to ‘bad things’, and this feels like the better, more ‘pure’ version of Emily?
Emily Troscianko: Yeah, definitely. I was so judgmental about almost everything, as most people are. I mean, probably some people manage to stay a bit nicer than I did when I was starving, but the amount of judgment and dismissiveness and general snooty looking down my nose at other people and other things – that was the defining feature, probably, of my mental state while I was ill. Of course, it was as much about myself as anyone else.
So yes, the recklessness and the abandon of teenage Emily who had done all that outrageous stuff started to first feel abhorrent to me, and later to feel like another human being. How was that even the same person? It just felt utterly surreal. Sometimes I look back at teenage diaries or at photos or even just talk to people about how I’d been back then – sex was one of the things that was different. As you say, the ingestion of mind-altering substances was another.
But in all those senses, the openness to experience that the teenage version of myself had had, that was gone. I was just insisting that this tiny, tiny set of very dark, very cold, very hungry, narrow experiences was the other thing that I could either cope with or desired to have. That persisted until it didn’t, until the pastry in the morning started to get eaten. And with that, the flipside also happened. We talked already about the pendulum swing phenomenon.
First of all, it was just back to something that several of my family members said quite early on in the recovery, actually – six months, maybe even less than that in: “It’s like having the old Emily back.” That was a lovely reminder that they had those memories of Emily who wasn’t like this and that they recognised her. Of course, I wasn’t 16 anymore, but something a lot like her was returning.
But then it also had to go further than that. I mean, it didn’t go further in all respects with the drug-taking, for example. But with the sex, it actually did. Having fallen in love early in my recovery and spent some years with the man I fell in love with and had increasingly lovely sex with him, and that all having been great. Various destabilisations happened, most primary of which was my father’s death, very unexpectedly and young, and that made me do some more reassessment. I realised that actually there was still a need to do some catching up in the sexual and romantic realm in particular, and that I needed to not be in a monogamous relationship for a while in order to do some of that stuff.
So that was going further than just finding stability straight away; that was needing to go a bit to the other extreme to allow all that stuff to get worked out, just like with the meat eating. It was good and necessary to do that stuff, that sleeping around that I did a summer’s worth of.
You can always tell the post hoc story that makes every decision that you made into the right one if it all ended fine. And who knows, if I hadn’t done that, maybe it would also have been fine. But it did seem crucial at the time to, again, not be shutting off desires at source, not to be saying “It’s not okay to have these desires” – instead to say, “Yes, I have them, and I’m going to act on them now.”
Chris Sandel: The fact that you’d also had this happen before the illness, whether that is relating to the sex or the drug-taking, did that then help a lot when things started to come back online? Because I think about myself, I’ve taken a lot of drugs over the years, and I think of them in a very positive way. I think I’m a better human being for the experiences I have had with them, and that it’s changed my perspective on things, it’s allowed me to notice there are ways of feeling and seeing that would not have been available to me unless I’d done meditation for 10 or 20 years. But I think about those things in a very positive sense.
I know for you for a while that was obviously shut off. But did that come back, and knowing that had been something that’d been positive before allowed you to embrace it in a way that maybe wouldn’t have happened if you hadn’t had those prior experiences?
Emily Troscianko: Yes, probably. There are hundreds of behavioural psychological experiments that show that familiarity has a strong pull. So in that sense, the feeling of returning to something that at least was once familiar rather than having to strike off into entirely unknown territory – yeah, it’s a different feeling. It was probably easier for me to recognise the desire for what it was than if I’d never fully had or at least acted on such desires in the past.
But I think also the biology does take over, and even if one doesn’t have such excessive teenage experience to draw on, if you’re in the habit – as you need to be if you’re doing recovery properly – of observing what’s going on with you, and when you see something, feel something unexpected, maybe frightening, maybe just weird, not going “I won’t look at that; let me avert my gaze” instead of going “Hmm, what’s going on here? Does this require or ask some action from me?” – I think you can generally be confident that you will notice this stuff arising, and you will dare to act and see what happens as ever.
And hopefully the rigid moral judgments also fade as well as you get better fed and everything starts to soften and get more flexible. That applies as much to psychoactive drugs as it does to anything else. Just appreciating, again, that we’re all just a bunch of chemicals sloshing around and the social dividing lines between acceptable chemical interventions and not are utterly arbitrary and often have got it completely backwards.
All those things, again, they come up for grabs if you’re in the habit of not just clamping down on every moment, on every inclination, on every possibility for a slightly different experience than what you’ve had before. Sex is a nice example, but there are many others.
01:35:23
Chris Sandel: I know we’re getting short on time here, so the final thing I want to talk about – I know you’ve been doing experiments looking at reading literature and the connection between literary reading and eating disorders. What have you been looking at, what have you found? Talk about this?
Emily Troscianko: As I mentioned right at the beginning of our chat, ages ago now, I got interested in this question of what effects might having an eating disorder have on how we engage with stories, narratives of one kind or another. And also the reverse question: might the reading experience and process have some effects back on the eating disorder?
The data that we’ve generated in the study with Beat that I mentioned earlier suggested very strongly – I was really surprised by this finding – that there’s a really stark distinction between the effects people observe reading fiction about eating disorders to have versus the effects of reading whatever other kind of fiction they prefer. They could specify from a whole long list.
Specifically, the overall overwhelmingly significant finding was that on all the dimensions we asked about – mood, self-esteem, how you feel about your body, and diet and exercise habits – reading fiction about eating disorders was considered to have universally pretty negative effects, to be quite damaging, whereas reading whatever other kind of fiction you like was much more neutral.
Chris Sandel: Is this in people who already had an eating disorder or more in the general population, or people who had recovered from an eating disorder?
Emily Troscianko: It was all a bit messy because this was a survey study only. People were reporting on experiences from any time in their past, so often many years later, or even decades, and in this part of the survey we weren’t specifically asking people to state at what recovery phase they’d been when they had these relevant experiences. So it might’ve been a whole bunch. There’s a lot of noise in the data there, if you like. But we did find that the effect held for people both who reported personal experience with an eating disorder, either now or in the past, and people who didn’t. Although the sample of people who didn’t was a lot smaller. I was really surprised by that.
Chris Sandel: Yeah. So what is the next bit of research? How are you going to be expanding on this, if you are?
Emily Troscianko: I was surprised by that largely because all the bibliotherapy theory – the theory of how books can be therapeutically useful – suggests that you basically need to find a book with a character who’s going through as similar a thing as possible to what you’re going through and then experience their journey along with them, probably have some cathartic release moment, and then do some magical problem-solving in response to how they get through things. So you’re going for maximum similarity and then you’re essentially mimicking their trajectory.
Chris Sandel: The Hero’s Journey in whatever you’re dealing with.
Emily Troscianko: Exactly. That always seemed a bit too neat and simple to be true. [laughs] But I also felt there’s presumably some truth in it, that reading about people going through your kind of thing is probably helpful in some way. So I was really quite shocked by the data that suggested the opposite – actually, read any other kind of stuff apart from this and it’ll probably be a lot better for you.
So those survey data were extremely revealing. I didn’t manage to get grants to do follow-up studies as I’d hoped to on that for a few years. And then I found myself trying to write a book. I’d thought that the book would be basically a collection of blog posts with a bit of topping and tailing. Quite a lot of blog readers had said, “Are you planning on writing any kind of book?” I thought it would be quite a nice satisfying and fairly easy way to go to do this kind of blog-to-book sort of thing.
Started trying to do that, realised it really didn’t work at all. Spoke to a literary agent about it, who said, “It needs to have much more of a narrative arc. You need to put your story as a whole overarching framework for the book.” I tried to do that and that really didn’t work together with the blog posts. It was all just not working at all.
Then I was getting to the bit on control, and I was really not looking forward to writing about this because it’s such a huge topic, and it would be easy to write a million words about it and get very muddled and overdone. I thought, how can I streamline this? I tried out a question-and-answer format, and that seemed to work really well. Then I thought, maybe I could use this Q&A structure for more of the book.
Anyway, I ended up rewriting the whole book basically in dialogue form. This seemed to work a lot better and had all kinds of interesting advantages in terms of what it allowed me to do and not do. But then I realised at some point, oh gosh, I’ve written a recovery memoir, haven’t I? It really hadn’t been my intention because the Beat study had confirmed my suspicion that they’re often not very much use to people and may actually make a lot of things a lot worse.
I think I was out gardening one day and I’d just been peer-reviewing a paper in which the author made some in-passing comment about the interesting discrepancy between the fact that authors of recovery memoirs or eating disorder memoirs in general tend to say they’re doing it in order to be helpful to other people, raise awareness, etc., but that they also often report that reading such books was unhelpful to them when they were ill. [laughs] I thought, oh gosh, I really don’t want to be one of those hypocritical people who – I didn’t have particular experiences of memoir reading in my illness because I stayed away from everything, but to do the research that finds that stuff and then just to go ahead and write and publish a book like this – that looks awful, and it could also do a lot of harm. This is no good at all, and I must do something better.
That was when I decided to conduct an experiment to find out how people might actually respond to this book in a controlled, supported way before deciding whether to publish it or not. So the current study, which we’re recruiting participants for now, is an attempt to do – as far as I know, I don’t think there’s any precedent to do this sort of pre-publication study where a book that may or may not be published on the back of the results that are generated is read by the experimental group. The control group are reading a different book that’s not at all about eating disorders. We’re taking all kinds of measurements before, during, and after.
We’ve got hard cutoffs to determine whether significant harm is being done, and if so, if the harm is observed, then the book will not be published. If there are specific ways in which edits could be made to improve the usefulness or decrease the harmfulness of the book, they can also be made. But I’m excited about this because it’s a way of, I hope, setting a bit of a precedent for taking more seriously this question of, what are we doing when we’re writing these books? What’s it really for? Is it actually just about getting a nice exploratory writing process for myself in the vein of what we were talking about earlier with fun therapy sessions that are all about uncovering all this old stuff? Is it about that, or is it really about helping people? And if it’s about helping people, will it really do that?
So yes, if you, listener, are at all interested in taking part in the study, it would be wonderful to have your participation. Hopefully Chris will link to the details in the show notes.
Chris Sandel: I will definitely link to that. Is there an easy website or link you can mention so that if someone doesn’t go to the show notes, they’ll at least hear it now?
Emily Troscianko: Yes, you can go to my eating disorder-devoted website, which is called www.hungerartist.org. If you go to the Research page there, you’ll find the details.
Chris Sandel: Awesome. I’ve never heard anyone attempting to publish a book in this manner, where they are letting the readers decide whether it should be published. It’s a great approach, given, as you said, that the harm that can be done – even if that’s not, obviously, your intention – if that’s actually what happens, then maybe it is better that this work that you’ve slaved over for so long doesn’t see the light of day.
Emily Troscianko: Yeah, and it’ll be sad if that’s the case, but far, far better than going out into the world and doing more harm than good. I would really hate that idea.
Chris Sandel: Definitely. Emily, this has been an amazing conversation. I have a ton of notes that we didn’t even get close to touching. I feel like I could chat with you for hours and hours. And as I said at the top, I want this to be, for anyone not familiar with you, their introduction – and I do completely suggest that you go and read more and more of Emily’s stuff, because there’s so much great content there, and there’s so much I’ve learnt. I know it’ll be useful for listeners as well.
So where should people go if they want to be doing that, if they want to find out more information? I’ll put it in the show notes, but where are the places people should go?
Emily Troscianko: Thank you. Yes, you should go either to the hungerartist.org site that I mentioned before, or my personal site is https://troscianko.com. But if you’re not Polish, you may find my surname hard to remember and spell. [laughs] You can also just look for Emily at Psychology Today. The blog name is also ‘A Hunger Artist.’ So some kind of combination of Emily, anorexia, Psychology Today should get you to me.
Thank you so much, Chris. It’s been such a fun conversation, and I hope that – coming back to our drug theme – I hope it has been an effective gateway drug to some less narrowly judgmental views on everything that it means to be a human being alive in this weird universe. That’s wonderful.
Chris Sandel: Perfect. I really encourage everyone to do that, to check it out, and thanks so much for your time.
So that was my conversation with Emily Troscianko. If you are struggling with an eating disorder or you are in the process of recovery, then I highly recommend reading her blog, ‘A Hunger Artist’.
01:46:50
I have one recommendation today for something to check out, and it is a documentary called The Rescue. It’s all about the group of 12 Thai boys and their football coach who got stuck in a cave that was flooded. This was something that made rather big news when it happened back in 2018, but I honestly knew very little about it. I knew there had been some boys stuck in a cave and there’d been a rescue, but that was it.
Basically, there are caves in Thailand that during the summer months are dry and you can explore them for quite a depth; they go on for kilometres. And then during the rainy season, they are shut because they fill up with water. The boys had played football in the morning, and then they all headed out to hang out and play in the caves, and then the heavens opened up and in a very short amount of time, there was an enormous amount of rain, and they got trapped in the cave.
The documentary is all about the attempt to rescue these boys, and it is the most insane story. I didn’t know much about cave diving before watching this film, and I now have no desire to get into cave diving after watching this film. But it is great that there are people who are into this because they were so needed here.
There’s some incredible footage as part of this documentary of what was going on at the time and as part of the rescue. It’s really well put together. It’s by the same filmmakers who made Free Solo, all about Alex Honnold’s climb in Yosemite National Park. I highly recommend checking out The Rescue. It’s been done by National Geographic, so you can watch it wherever you can find National Geographic stuff. I know in the UK, it’s on Disney+.
So that is it for this week’s episode. As I mentioned at the top, I’m taking on clients again. If you want help with an eating disorder or disordered eating, with chronic dieting, with poor body image, exercise compulsion, getting your period back, any of the stuff that I cover as part of this show, then please reach out. You can head over to www.seven-health.com/help and you can find more information there.
I’ll be back next week with another episode. Take care, and I’ll catch you then.
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