Semi-related: I'm currently interested in how people get into the seemingly closed and endless maze of believing in things that are relatively provably incorrect or at odds with their own interests.
My daughter has recently been diagnosed with an eating disorder, and she cannot get past wanting to lose weight, no matter that she's in hospital due to her heart rate having slowed down to alarming levels. She still wants it to go slower, as a challenge, as a goal, to show how strong she is in fighting her own body's will to live.
It's fucking crazy, but it's her reality. I do not understand how this kind of fantasy gets a foothold. I feel like the power of an idea is woefully underestimated.
Same goes with conspiracy theories. Maybe an idea has to fit like a puzzle piece into a real life scenario as a convenient surface-level explanation for something unpleasant or just unresolved.
I used to think the brain was a logic machine, but I think there are strong elements of it that are coping mechanisms. Cling to a fantasy that makes unpleasant thing less unpleasant. Don't know how that relates to potentially starving oneself to death, but that seems to be entirely on the table for ye olde brain.
In my experience, I've found most deeply embedded self-destructive ideas to be rooted in fear.
The brain and body are effectively locked in a paranoid "fight" state - "I know this behavior is unhealthy, but if I don't behave this way, then [insert irrational fear] will happen."
If you can figure out what she is afraid of, you might be able to help her walk back the behaviors from there. But trying to correct the behaviors on their own is very hard. Since the fear is usually irrational, the behaviors may be a relatively rational response to said fear. They may hold the fear itself as table stakes - not understanding that they are afraid of something that isn't real (i.e. I will never find love if I'm not as skinny as the other girls on Instagram).
Again IME - the feeling from inside the self-destructive brain is "I shouldn't be doing this self-destructive behavior, but I don't know another way to achieve X goal, and I absolutely need to achieve X goal." Asking the question "Why do you need so badly to achieve X goal?" is usually a good start to defanging the fear.
Thank you, I will work on getting an answer to that question today!
Not the underlying fear that you mention, but seeing her reaction to being asked (forced) to eat is reminiscent of being asked (forced) to pat a spider.
I'm not sure if visceral, immediate fear maps to an underlying fear or not, but fear seems to play some part at least.
No disrespect, but maybe you should instead be working on getting her into therapy instead of trying to be her therapist. If she is not inclined to be honest with you or herself in the first place, you don’t have the tools and are too close to the situation, especially if you are the one who is the “cause” (regardless of whether YOU think you do something to be the “cause”).
A therapist is an independent person who is completely outside that persons life and their situation and is more likely to have the appropriate tools, or at least more so than a parent will (no matter how many TikTok’s they might see or blogs they might read).
And if she is resistant, explain that “this is someone who you can talk to; I don’t expect anything, I’m only asking that you just go talk with them about whatever you want. It’s not my business what you discuss, and I won’t ever ask you to tell me what you discuss. You can talk about your homework or the sky, it doesn’t matter, I’m only asking that you go talk to them. If you talk to them a few times and don’t like them, we can find someone else. Again, I have no expectations from this and I’m not trying to “fix” you, it’s just someone you can talk with and who might be able to make good suggestions about whatever you discuss…no more, no less”. And then, more importantly, you have to both believe and respect it.
I'm bang up for any suggestions, all good. Under no delusion that I know the right thing to say in this situation. I've actually found it difficult to find the right time to say, almost literally, anything; which may actually be a good thing (in minimising my opportunity to make things worse).
She has been seeing a psych for a month or two (regarding her 'minor' self harm, the eating disorder hadn't "presented" at that time). She's generally pretty closed about her emotions, but she did start opening up after a few sessions. Not that it was able to prevent the decline towards the current situation.
We've asked her "team" at the hospital whether there's a psych involved in her program. They said no, for two reasons:
1. They're currently understaffed in that area
2. They need to get her weight / nutrition back to a baseline level because 'starvation brain' is, essentially, not worth working on - it's not functioning correctly.
Despite that, they said they'd still see what they can organise.
We've also started the process to getting an eating-disorder-specific psych booked for when she's discharged from hospital.
Dr. Becky on Andrew Huberman this year said something like:
The first thing you should do when your kid is feeling something is to just say, "I believe you."
Don't tell her that she really is skinny, or that she really is beautiful, or that she's not thinking right. Don't tell her those things because what you're really saying is, "I know you better than you know yourself." That, unintuitively maybe, damages self confidence - where self confidence is really just "believing oneself."
If you plant a seed of doubt that she doesn't know herself and that others know more about her than she does...
(Obviously this is about validating her feelings and not validating self harm, which is nuanced and could probably use some professional direction or deep thought about how to approach this in a way which doesn't encourage deeper affirmation of the self image)
Anyway, I wish you luck. That sounds gut-wrenching and terrible. I hope you and your family can safely pull through on the other side.
Interesting. Yeah, fear being a component of these things makes sense to me from an evolutionary perspective. Self-harm makes sense if your arm is pinned under a boulder. I think the psychology of these conditions is closer to that than anything else.
> She still wants it to go slower, as a challenge, as a goal, to show how strong she is in fighting her own body's will to live.
I closely know an 18-year-old who decided to show his body that there are no limits in sport. He trains an insane amount of time (more than professional athletes) despite his body not following up.
He had a heart alert, and the cardiologist told him that the next time they will meet at his cardiac arrest, if he is lucky.
This absolutely did not change his mind.
He is intelligent, has ample opportunities to go forward in whatever he would like, lives in Western Europe, comfortable life and what not. He could be an excellent amateur athlete, competing at university level and doing well but he just wants to get his body past the breaking point.
The only hope is that he will mature enough to realize this in a few years, hopefully survive by then without serious impacts on his health.
Everything I the head, and this is an uncharted world.
Over-exercising is also a symptom of anorexia. A kid in the same ward, 12 or 13 years old, presented anorexia by obsessively exercising.
The desire to take it past the breaking point definitely puts them in dangerous-thinking territory.
At 18, though, I'm not sure how much help you can force on them. I'm vaguely concerned that, if my daughter has issues past 18 then what can a parent force given we're no longer a legal guardian? Could she call the police and we're arrested for some kind of restriction of liberty or kidnapping or something? She has literally said that she can't wait until she's 18 so she can leave and follow this starvation pursuit outside of our influence.
(the disease is horrible in that they literally are thinking and believing these things and there is no way to reason with "it" that doesn't reinforce the position - this is the first thing I've come across where logic and rationalisation are useless tools).
I was not correct with past the breaking point -- it is more with no regard to a breaking point, he is not suicidal at all, just believes that he can do more.
He is very happy with his body and eats a ton (and healthy) to build muscle and strength. It is just that this is way, way too much in terms of effort and time spent on exercising. There are plenty of articles on the topic of people of all ages who got addicted to sport and needed professional help to break the dependence. At least they wanted help.
His parents are not looking at forcing him to do anything, this is not in the picture at all. They want to help him. He has a good relationship with them and is leaving the house to study as expected (and normal)
Yes he did but this was not the trigger. The trigger is much more complex with being the second in the brotherhood, needs to be different from the rest, and - certainly - influences from anime etc.
I realized how difficult it is to relate to someone's mind without being the adult who tells you everything (and therefore you do the opposite)or to try to find ways to slow down the madness.
I used to run IT for a rehab healthcare company that did chemical dependency and eating disorders. The number one thing to understand here is that she has mental health problems, that is the root of this. She's not choose to believe fantasy, there are mental illness aspects that are warping her reasoning processes. She needs to engage with therapists as soon as possible. I'd be happy to make a couple of suggestions.
The approach being taken (by the hospital) is to get her back to a healthy weight and level of nutrition before starting therapy because a nutrient starved brain doesn't respond to psychology / therapy.
I've seen hundreds of kids go through the program where I used to work, and it always made me incredibly proud to work there. She can do it, 100% no questions. It won't be easy, but she can do it. Sounds like she has a great parent. Good luck!
The last couple of days she's been noticeably better personality-wise (likely as a result of increased nutrition levels), but it's a very "up and down" kind of illness, it does mean that she's still in there and not totally swallowed up into the beast.
I'm fundamentally optimistic, and more optimistic now than I was a week ago.
The way the hospital gets past the 'not wanting to eat' is they give her a nose-feeding tube, through which they syringe a nutrition liquid. This is their base for getting them to non-starvation mode. My daughter had been eating enough to have tube removed a couple of days ago.
Having said that, it's a 12-month-ish program, and potentially a lifelong 'back of your mind' concern.
> “I feel like the power of an idea is woefully underestimated.”
You’ve heard of the “meme”? That afterthought of idea by Richard Dawkins? I first learned of it during COVID lockdown. There was a post—somewhere—linking to a post from NASA making a bunch of their publications available for reading. In these was a whole anthology titled Cosmos and Culture. One of the articles is by a professor and writer Susan Blackmore. She wrote an article, something like, What The Pandorans Knew. In it she makes the argument that what we will find, if we explore the cosmos past earth, is most likely not alien civilizations, but the remains of extinct civilizations. She argues that ideas are in fact dangerous and might just be the death of civilization. And with this in mind, we’re more likely to find evidence of the extinct civilizations than live ones.
It’s a radical idea. At least that’s what I thought until people in positions of trust started into their non-scientific medical ideas during COVID.
While I find memes of great interest, don’t expect to find memes beyond a curiosity.
The big problem is, what can you do with memes that you can’t do with the current academic orthodoxy? I think if it like someone espousing on the merits of their favorite programming language, and the main line language users scoff and say they have work to do.
Neither speculative non-fiction, nor meme theory, nor programming languages compare to the matters of health and wellness. This is the crisis of our time.
Wishing your daughter the best. I can’t imagine how devastating it must be to watch your child go through something like that and feeling powerless to help.
Humans aren’t rational animals, they are emotional animals. They believe what they want to believe, emotionally. Body Keeps the Score kind of stuff, which focused on acute amygdala hijacking, but should have talked a lot more about continuous amygdala hijacking.
I’m sorry about your daughter I hope she gets better.
I've been through that. Even with a BMI below 18 when you already look like a walking skeleton and can't do more than a minute of physical activity without having to rest, you still continue seeing yourself in the mirror as obese, focusing in on small imperfections and exaggerating them to absurd levels. I really saw myself as fat, even though the weight was far below the normal range. You don't believe what other are saying because the mirror is objective and won't lie to you.
It can be fixed though — the hospital stay after passing out from low glucose levels finally straightened me out, but she really needs to figure this out for herself. Good luck.
Thank you. I recently spoke to someone who used to be an alcoholic and it also took them a somewhat near-death experience to create sufficient internal will power (or realisation) to change their behaviour.
It must come internally.
We keep working on what a wonderful happy life she used to have, hoping that such reminders will eventually seep in to create her own realisation.
It's probably a mixture of A and B, and maybe some C, etc.
I believe a necessary element is that people want to be "better" (eg. ahead, smarter, or etc) than others, whether that's having some sort of "secret" knowledge or just wanting to be a contrarian.
I have a cousin who went through many years, from her teens on, of anorexia, bulimia, and substance abuse. Somehow she still managed to become a vet with a decent career, with parents actively supporting her in getting different treatments.
The one treatment that finally broke the hold of her eating disorders was a live-in program at a hospital where all they did was, as a group, prepare and consume three square meals a day. It was like nutrition 101 coupled with some basic household management. Her words: "It had never been laid out like that for me, and I just didn't know it."
Does that mean it would work for your daughter? Maybe, but one obvious thing was that it was the right treatment at the right time for my cousin. A decade earlier she'd probably have blown it off or missed the point. The only thing I can say worked for her, is her and her family not giving up, hanging on and trying different things, until some magical combination of action and receptiveness met up.
As a friend to others with similar issues, I've seen the same thing: it's usually a lucky combination of action and circumstance. No treatment is guaranteed, no approach failproof. As you observe, the human brain is, in large part, a bunch of coping mechanisms (most therapists these days would nod excitedly at that understanding). It's not reasoning, it's reflexive defensives, and can take a long time to untangle.
Don't lose hope, and keep trying. And consider counselling for yourself and your spouse. This is traumatizing to you too, and getting support yourself to keep at it also helps.
I am so sorry to be this guy, but did she tried CBT with a trained professionnal? You should allow her to vet the therapists (some are bad, other are worse, but good ones definitely exist).
I'm not in the "you should seek help" camp, at all, but for eating disorders in particular, randomized trials show that CBT is extremely effective, on the short and long term.
She was seeing a psychologist in the few weeks prior to her hospitalisation and my wife tells me that CBT was part of that.
Post hospital discharge, hopefully in a couple of weeks, we'll be doing FBT (family based therapy, I think) which, according to this morning's information session, is rated above CBT in it's effectiveness.
There's a 12-month-ish program she'll be going into once she's recovered to a healthy weight / nutrition level.
With our societal move away from religion, we lost (what I think is) the useful metaphor of demons to explain some behaviours and frankly, it is my theory that demons and ideas are akin to viruses : they come, take ahold of who they can, thrive where they can, to take everything they can until they can't.
From the short post you shared, your daughter seems, for a lack of better words, possessed by this terrible terrible idea. Sadly, I have no idea (!) why some ideas stick to some whereas other won't attract ideas even close. But yeah, you are right, one should never consider their own thoughts to be absolutely true.
Sorry that you got this lesson is such a hurtful format. Hope your daughter gets better.
>With our societal move away from religion, we lost (what I think is) the useful metaphor of demons to explain some behaviours
What we lost with religion is the belief in literal demons controlling people as an explanation for human behavior. Demons as metaphor is not a religious concept per se, and such metaphors still exist within secular society.
Whilst I'm not religious, there's a definite sense that my daughter is 'possessed' by this idea. Not necessarily like demonic possession but almost like a slave to this idea as her master.
She is a chattel to what started as an idea but has grown into an entity to be obeyed.
My daughter has recently been diagnosed with an eating disorder, and she cannot get past wanting to lose weight, no matter that she's in hospital due to her heart rate having slowed down to alarming levels. She still wants it to go slower, as a challenge, as a goal, to show how strong she is in fighting her own body's will to live.
It's fucking crazy, but it's her reality. I do not understand how this kind of fantasy gets a foothold. I feel like the power of an idea is woefully underestimated.
Same goes with conspiracy theories. Maybe an idea has to fit like a puzzle piece into a real life scenario as a convenient surface-level explanation for something unpleasant or just unresolved.
I used to think the brain was a logic machine, but I think there are strong elements of it that are coping mechanisms. Cling to a fantasy that makes unpleasant thing less unpleasant. Don't know how that relates to potentially starving oneself to death, but that seems to be entirely on the table for ye olde brain.
Careful what you consider plausible folks!