I ended Part 1 of this series by asking when someone might WANT to have anorexia.
When might you actually want to be repulsed by the thought of eating food?
Put another way, could anorexia ever be “useful”?
Well it is a standard question that I have asked of every so-called problem that I have been told about or come across over the years.
In what way might the presenting problem or symptom or complaint actually be “useful” to the person?
How might depression be useful, or phobias, grief, alcoholism, self-sabotage, low self-esteem, narcissism, or whatever?
This is where you get the idea of “secondary gain”.
Secondary gain is when there is a second or hidden motive for an action. For example being sick can also be a way of avoiding dealing with an issue, as in a child not wanting to go to school or a worker not wanting to face their boss.
This is often implied as a bad way to deal with things.
We’re meant to be upfront, have no secrets, face our fears, not keep hidden agendas.
However the reality is that humans are complex, and being indirect in going after an outcome is an important choice to have.
Some things are quite well dealt with in a secondary way.
Could there be some useful but secondary gain in having anorexia perhaps as a way of attracting sympathy, gaining attention, getting control of emotions of fear or anger, etc etc?
I suppose yes.
Every problem can have secondary gains.
Personally however I don’t think these questions generally lead to useful therapy. When I have explored secondary gains they have often opened up really fascinating stories with many twists and turns, but in the end the problem is no better for having done so.
Secondary gain inevitably happens, but it almost always remains secondary.
Let’s go back to the question with a different emphasis.
WHEN or WHERE might a particular problem be useful?
In the case of anorexia I have only one suggestion for a context.
If I was drifting on a small life raft in the middle of the ocean for days or weeks, and all I had to eat was food that I knew to be contaminated and fatally poisonous, then in this extremely limited situation I could imagine being much happier to have anorexia.
Instead of wishing I had food or being tempted to eat the poisonous stuff around me, I would be happy that I finally had no one pressuring me to eat. Bliss!
But most people with anorexia are not stranded at sea with poisonous food, so in Part 3 I will move on to what else might be going on.
-Dr Martin Russell