Anorexia Nervosa, Denial, and a Bad JokeAuthor: Em Farrell
A psychiatrist, teacher of psychotherapy and outstanding clinician sometimes asks his patients "What is the longest river in the world" They are meant to answer "The Nile". He would then smile and say 'That's you" and expect them to realise they are in denial. It sounds corny and rather confusing, but interestingly the aspect of surprise, which is so important in getting things through impenetrable barriers often works. Interestingly, they are now not so certain that the Nile is the longest river. There is a debate about whether it is the actually the Amazon, which wouldn't really work so well, unless you just wanted to confuse the person you were wanting to help.
There are different varieties of denial from the straight forward 'No, I don't want a piece of cake' when you really do to Bill Clinton's "I did not have sexual relations with that woman"; where that woman was Monica Lewinsky. Both of these examples are conscious ones, denial and lying are sometimes close companions. In the case of anorexia we are talking about something of a totally different order, we are talking about unconscious denial. This means that the level of denial is so deep that you are unable to know it, unless helped over and over again to understand it.
This is part of what is sometimes referred as the delusional part of anorexia. In my experience of working with anorexics over many years they are very aware that they eat very little, and that is often very hard to do. They are aware they weigh very little. Their hatred of fat means that any fat they have on their body is viewed as intolerable, which means they rarely view themselves as thin enough. To be thin enough would be to be fat free and to be fat free would mean being dead. Every cell in our body has fat in it and our brains are made up of up to 60% fat. It is a vital substance for us all.
But back to an anorexic's denial. Given that an anorexic knows she or he eats very little, often over exercises, and hates fat as seen on the body, what is it that is being denied? The answer is the anorexic is denying the danger she or he is placing themselves in. Figures vary between 5 and 20% of anorexics who die as a direct or indirect result of their illness. This makes anorexia the most deadly of all psychiatric diseases. It leads to more deaths than bi-polar disorder, unipolar disorder or schizophrenia.
This is the cost of denial. What is being denied is the danger that the anorexic puts him or herself in. A body cannot survive without nutrition and yet a sufferer of anorexia is denies this. Her denial is not surface, slight or fake. It goes right through her. She believes she can survive on air, or very nearly. One of the main jobs of a good therapeutic intervention is to get to the place where this level of denial is not only questioned, but acknowledged. When a person makes a decision they want to live and fight for themselves in the face of a self-destructive part of themselves they can ad usually do get better, although it is very hard work.
Em Farrell's new book A is for Anorexia: Anorexia Nervosa Explained is now available at Amazon, or go to www.abcofeatingdisorders.com to get a sneak preview. It is available FREE as an eBook from March 30th to April 1st on Amazon.
Em Farrell is a psychotherapist, author, and speaker. If you or a family member struggle with an eating disorder she can help you. She uses her own skills and those of her team to create a bespoke solution for you.You can find information about her at www.emfarrrellpsychotherapy.com and about her work and writing about eating disorders at www.abcofeatingdisorders.com