Don’t tell me I look well. But say it anyway

The reaction of someone with an eating disorder to comments on appearance reveals a lot about the psychology of the illness

While I was in treatment, we had a group every week where we would all choose a situation that may have been challenging or upsetting to share with the others. In turn, we’d give support and advice. One of the most frequently occuring scenarios was when someone had said ‘you’re looking well’. Such a throw away comment, which we all use on a daily basis, can ruin an entire day for someone with an eating disorder. It reveals a lot about the psychology of the illness, and the fact that it’s not just about weight and appearance.

“You look really well, Thomas”. Boom. It’s like a wrecking ball to the stomach. A red flag snaps up in the mind and the bull charges: faster and faster it runs, destroying everything in its path as it rampages through your head. Panic ensues. Blind terror. ‘You’re fat. You know you are. She’s just confirmed it. Oh my God, you’re losing control, you’re worthless, you’re weak, you’re pathetic. So, you’ve decided to start looking after yourself now? You’re not worth it, stop being selfish, you arrogant pig. She’s judging you: you’re fat. You’re not ill anymore. No more food today…’

“Your mother says I’m not supposed to say that, but I don’t see why I shouldn’t. You are looking well”.

Four words. That’s all it took. She only meant well, my Grandma. But with those four, casual words, my day was ruined. The disorder was on the march, back in control. For the rest of the day, eating would be a painful battle. But why shouldn’t she say it? Why shouldn’t she be able to tell her Grandson that he’s looking better? After all, after two months on the eating disorder ward, he probably is looking slightly different: less dead. And why couldn’t I take it as the compliment that is was meant to be?

It got me thinking. How many times had I heard that during recovery and found it as difficult as someone telling me I was piece of f***ing s**t? It’s such a common, casual prhase, so why did it mean so much to me, and why was it so triggering to the eating disorder?

Is it just about the looks?

On the surface, it would be easy to assume that not being able to tolerate a compliment on your appearance confirms that eating disorders are all about looks, about people not being satisfied with their appearance or size or shape. Of course, it’s true that eating disorders are characterised by an irrational loathing of the way you look, your size and weight, and so any comment on your appearance is bound to be uncomfortable because it highlights the part of you which the eating disorder makes you hate. It’s similar to the fact that I was physically unable to look in a mirror for months during recovery because I could not bare to see my body and the way it was changing.

By commenting on how you look, they are drawing your attention to that fact that your body is changing, and that they are looking at your body and noticing those changes. For someone with an eating disorder, the thought that anyone is judging your body confirms to the disorder that worth is based on appearance.

Furthermore, in recovery, you know full well that your body is changing, that you are putting on weight (if it was anorexia that you were recovering from, bulimia and others may be different), and this is painfully difficult to accept. Every fibre of your being tells you that you are doing the wrong thing. For so long, the disorder has convinced you that your worth is based on your size, that you are a bad person for putting on weight (even though you would never judge anyone else on their size, shape, weight or appearance – paradox, right?).

YOU DON’T HAVE TO BE UNDERWEIGHT TO BE SUFFERING AN EATING DISORDER!!!

It’s the control, stupid…

To assume that this is all about appearance is to misunderstand the psychology behind an eating disorder. For most people I have spoken to, and in my own experience, the disorder wasn’t caused by wanting to lose weight or to change their body. Although body dissatisfaction can increase the chances of developing an eating disorder, it is not a necessary precursor to the illness. For many people, an eating disorder is about CONTROL. Maybe that seems counter-intuitive since, they are clearly not in control of their health, or their life. But, the disorder gives the false impression that you are in control of at least one thing in this uncertain, scary, unpredictable world.

It did for me. Couting calories, weighing myself, having strict rules around food all made me feel like I was in control of myself. And for me, that was crucial because I thought I was a bad person, therefore I HAD to keep myself under control. Also, anxiety around acceptance and social judgment because of confusion over my identity made me believe that I had to control not just myself, but the world around me. The disorder made me believe that I was achieving this.

So, to be told that I was looking well, to me, was to be told that I had put on weight, which meant that I was losing control not only of myself, but of my grip on the world around me, exposing me to the fears and anxieties and insecurities which had driven me towards the disorder. ‘You look well’ = you’ve lost control = you’re a crap human being.

This links in to another meaning which you come to interpret from that simple phrase. By looking well, which innevitably in recovery means putting on weight, you are letting go of the eating disorder. That’s what recovery is: disconnecting from the illness, building a new, healthier, life. But when you are in the grips of an ED, that’s not a good thing. It took me about three months of inpatient treatment to finally accept that I wanted to fully recover. That’s because, for so long, the disorder had been my life: it was familiar. Most importantly, it was known, in a world full of terrifying unknowns. In the unknown you can get things wrong, you can be judged. So the disorder, despite its severe, potentially fatal health implications, was safe. It was like a security blanket: try to take it away from a small child and they will feel lost, scared, anxious, unsafe.

In a world full of unknowns, it was a known

An abusive relationship

One of the best analogies I have heard for an eating disorder compares it to an abusive partner. You know that it harms you to stay with them, that you are not really living, but you cannot imagine life without them and turning away from them is the scariest thing imaginable. So being told, ‘you look well’ tells the eating disorder that you have decided to separate, to divorce. And all that anger of a rejected, abusive partner, is directed at you. That’s scary. And it makes you want to run right back into its arms.

And this in turn feeds into another thought process triggered by this throw-away comment: that you are no longer ill anymore. Therefore, who are you? The illness has become your way to measure your worth, it has become your identity and one of the only remaining ways in which you can interact with people: through their pitty. ‘You look well’ = you no longer have an eating disorder = you’re worthless, you’re weak, pathetic, you’re wasting everyone’s time here in recovery. Again, you’re a bad person.

That’s why telling someone with an eating disorder that they ‘look well’ can be so dangerous and damaging.

There’s a time and a place

Given everything I have written, you’d think I would advocate anyone who knows someone with this illness never to say those three words: ‘you look well’. But, now that I am on the other side of the disorder, I actually think you should. Bear with me.

DON’T say it to someone in the early stages of recovery, or if they have not yet accepted that they need help. At this point, saying anything about their appearance could do more damage that good. As I have said before, don’t coment on how they look, but how they feel.

However, being exposed to such triggering comments is a really important part of recovery. It exposes you to all those deep beliefs behind all the hidden meaning you have taken from such a simple phrase. And it exposes you and gets you used to the real world, where people do comment on how you look, where people are constantly talking about food and weight and weight-loss and dieting in the office or at the dinner party or on the bus. You can’t hide from triggers forever. You need to build up a tolerance to them so that eventually, they mean nothing to you.

And part of recovery is accepting your body. I knew I was making real progress when someone said ‘you’re looking well’ as I greeted them, and all I said was, ‘thank you’. At this point, it didn’t matter to me. In fact, I could take it for the compliment it really was meant to be. Because I was looking better. I was no longer the emaciated, dead-eyed, grey figure floating through life. And I should be proud of that and what I had achieved. I was finally letting go of the disorder. I was taking back control.

Such a simple phrase, but it reveals so much about the psychology of an eating disorder and of recovery. For those people who know someone with this illness, it can feel like you are constantly walking on egg shells. But there should, and will, come a time when you should start to say what you really think, even if in the beginning, it might upset the person you love.

If you or someone you know may be suffering with an eating disorder, here are some links to find out more information about the illness and treatment. Please don’t think you’re not ‘ill enough’: if you need help, ask for it…

Recovery information from Beat, including helplines

NHS information about different types of disorders and how to find help

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