- Dear Ana
- Good cop, Bad cop
- Ana vs The Kid
- Moving on
I’ve previously mentioned the concept of externalisation – a therapeutic technique where somebody with an eating disorder is encouraged to view the disorder as a separate entity rather than part of themselves. In one of the comments threads Jessa asks the following question:
I’m not sure if this is actually what you are saying, Z, so correct me if I am wrong, but it sounds like you, too, have a bit of difficulty separating out what is The Kid and what is Ana. Within the conception of The Kid and Ana as separate entities (which is a fine conception, but not how I tend to look at this), I think it is actually a helpful thing that you have difficulty separating the two. In treatment, it seemed like all the professionals were always telling me I had to separate myself from Ana and I had a really hard time doing so (not only because that isn’t a metaphor that is helpful to me) as did many of the other patients I was with. I think it is useful that you have difficulty separating The Kid from Ana, because The Kid may be having that same difficulty, which gives you a common ground.
Ana, the malevolent little ghost that jumps around inside The Kid’s skull, makes for a convenient metaphor that’s promoted as therapeutically useful. The idea is that one can separate all about The Kid that’s part of the illness – the food obsessions, the compulsive exercise, the anxiety, the ritualistic behaviour – into a handy little bundle away from everything else that makes The Kid who she is. That part of The Kid that likes football, is interested in cats and horses, listens to Kanye West and appreciates the cinematic craft of Mr Zac Efron – that’s meant to be the ‘real, authentic’ version of herself, which can then turn around and give Ana a damn good kicking.
One thing that doesn’t tend to get mentioned is the extent to which the staff seem to need to believe in Ana The Evil Ghost. Staff do actually talk in the nurse office and the ward round about “the anorexia” making The Kid do this or that. There’s a strong element of needing to compartmentalise Ana away, partly in order to keep maintaining a benevolent view of The Kid in the face of yet another round of lies, manipulations and tantrums. It wasn’t The Kid that sneaked into the bathroom to do some surreptitious exercie and then threw a screaming fit when challenged about it; it was Ana that did that.
Ana may be a fiction, but arguably services might be better if staff maintained a similar fiction with regard to other conditions. Borderline personality disorder springs immediately to mind. Perhaps if staff we were say things like, “Bippidee has just sent her shrieking down the corridor and kicking the wall,” they might be less likely to instead say, “Oh, for fuck’s sake, that attention-seeking cow is really getting on my tits.”
Though interestingly enough, some people with BPD do seem to compartmentalise their disorder into Bippidee. Becoming Hannah’s blog has an example.
I guess it’s like telling a cheeky little munchkin of a kid not to press that big shiny red button that says ‘PUSH ME’, leaving the room and expecting not to hear the sirens, see the flashing lights and have to evacuate the building.
Crazy bitch pressed the sodding button. I told her not to, she did it any way. Of course she did, temptation is pretty tough to resist at the best of times, let alone when tart-face has moved in.
What I want to know is why I can’t control this, I leave the room for 2 minutes and she’s swiped my mobile and caused havoc.I’m trying to look at this logically, obviously there are not two of me, there is no one physically causing this trouble other than myself. I just keep falling off the wagon idling its way to stability, and when I do I feel ridiculously free and liberated, until I realise what I’ve done and then I feel out of control and angry.
I should probably bring this blog post to some kind of conclusion about the extent to which it’s accurate or useful to compartmentalise a mental disorder away from a supposedly more true and authentic version of oneself, but I’m struggling somewhat to find a way to summarise it. So instead I’ll just hand over to the comments thread for you lot to debate and hopefully come to a conclusion better than I can.
The idea is that one can separate all about The Kid that’s part of the illness – the food obsessions, the compulsive exercise, the anxiety, the ritualistic behaviour – into a handy little bundle away from everything else that makes The Kid who she is.
The Kid’s personality might just be a little obsessive and prone to anxiety. Perfectly ‘normal’ people have their little rituals like taking a lucky charm into an exam or being particularly scared of something a little irrational (like spiders). That, in itself, isn’t a problem. Children, and particularly teenagers, are sometimes a little bit sneaky and manipulate. That’s normal too. Ana exploits it – but it might be there anyway. If you try to separate the two completely, then don’t you assume that The Kid is totally perfect? That’s a lot of pressure.
IME…
someone who is suicidal cannot see a life other than the way it is. But if you ask them would they rather things be different or be dead – they pretty much all say ‘different’.
This applies to all people (illness or otherwise).
Whether it’s an illness or whether it’s an extension of malformed personality that’s responsible – I don’t know of many people who are happy with what they’ve ‘got’ when it causes disruption in their lives or causes hurt to them or those around them.
Kids perhaps have a harder time of seeing (and adjusting to) that because of the natural egocentricity and the superficial immaturity of friend/relationships at those ages.
Uhmm I’ve been hearing a lot abut part selves recently, about the different sides to our personality that carry different traits and cause different problems. Thern there’s the bits that aren’t actually us at all but things that have been internalised, learned behaviours etc. that feel instinctive but not quite right or natural for some reason that you can’t quite put your finger on. Figuring out what is what is tricky though, sometimes the real bits are being conterproductive and the false bits productive and vice-versa. Sometimes the false bits feel more real than the real bits.
Anywho for the sake of trying to wrap up my reply, is it accurate or useful to compartmentalise a mental disorder away from a supposedly more true and authentic version of oneself? Sometimes but I think it depends on the disorder and the individual.
When I had a diagnosis of depression, compartmentalising it was sometimes helpful because then I could say that this wasn’t me, I wasn’t just depression. At the same time when antidepressants and things come into play it can be easy to absolve yourself of responsibility rather than trying to figure out why it is that you’re so damn miserable.
Then my diagnosis changed to BPD (or Bippidee, I like that one). Compartmentalising became a little trickier because to start with it does feel like you’ve basically been told, “Oh hai, there’s nothing wrong with you, except that you’re just wrong.” The compartmentalising became less relevent in some ways because I had to start examining my actions as a whole and within a new context but at the same time it was useful to stand back and isolate things, put them under the microscope in order to better understand how the bigger picture works.
So yeah, different things for different situations and moments in time.
I go off for an internet-less week of bookbinding and look at what I miss!
This gives me a little bit more insight into the troubles I had while in eating disorder treatment with the concept of identity. The staff kept telling me that I should define my identity separate from “Ana”, that I should figure out who I would be without my eating disorder. I was really confused about the whole thing. How was I supposed to know who I was without an eating disorder or depression or anxiety?
I was in eating disorder treatment when I was 20 and I had been sick since I was 14. Sometimes staff would try to help me imagine what I would be like if I wasn’t sick by asking what I was like before I was sick, but that really wasn’t helpful. It would be inappropriate for me, at 20, to suddenly go back to being the person I was at 14, nor did I want to be
that person again.
In light of what you have said, Z, I think that part of my difficulty in understanding the concept of identity was that the staff were doing just what you say you do, making a hard distinction between Ana and The Kid. Like in-the-margins said, this tends to become an assumption that, sans Ana, The Kid is perfect. I saw this a lot. There was an unwillingness on the part of the staff to let me take responsibility for negative things about me. They blamed all these things on Ana or depression or whatever. It would have been fine if their attitude was, “I can understand why you would have done that in light of Ana,” but the attitude of, “you are blameless because Ana did it,” was something I couldn’t understand and refused to buy into. (And this whole “Ana is evil, The Kid is perfect” thing is a good example of staff using the same cognitive distortions they try to rid their patients of; black-and-white thinking in this case.) The staff were thinking of me in terms of this false dichotomy that I didn’t understand, so their version of my identity was very different than mine, it was very one-sided.
Eventually I did come to understand the concept of identity, but I did so by understanding the neutral part first, testing it by asking them if I was on the right track. Once I was on the right track and understanding what identity was, I filled in all the negative bits without their help, and managed to fill in the positive parts much later once my depression abated. They presented identity as being everything about me: what I like and don’t like, what I do, your habits, etc. But when I would say things like, “I have a nasty procrastination habit,” it was all, “no, that’s the depression, not you,” it was confusing because I thought that fit their definition, but they told me it didn’t. And of course I started with all the negative things first because I only thought of myself in negative terms, so everything I ventured as being part of my identity was struck down. My entry into understanding what they meant by identity came in the form of a list of very neutral questions: favorite color, hobbies, favorite school subjects, etc. Those neutral identity areas were my bridge into understanding identity. I’m no dummy, but they sure made identity a difficult thing for me to understand.
Obviously I’m not fond of separating Ana from The Kid like this. That being said, I think that part of why personality disorders are not separated from the patient in this way is partially definitional. Personality disorders are defined as things that are pervasive and inflexible; having a “wrong” personality. Personality isn’t something that is seen as being as changeable as a disease. The diagnostic criteria attest to this: you aren’t supposed to diagnose personality disorders in minors because they are growing and changing so much and haven’t settled into a consistent personality yet, and the diagnosis has to be based on long term traits. This is why the prognosis is grim for personality disorders, personality isn’t something subject to change in the short term the way eating disorders are sometimes thought to be. Perhaps you could think of Bippidee as something separate from the individual, but that might not be done partially because, if you are assuming the patient will never be separated from Bippidee, why bother thinking of them as separate? Whereas there is an assumption that Ana can be separated, eventually WILL be separated from The Kid, so it makes more sense to treat them as separate entities.
I hope that all made some sense. This is all still kind of amorphous and hazy in my mind; I know it is there and real, I just don’t have good ways of explaining it yet without grossly oversimplifying.
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