Ethical Questions About an Anorexia Recovery Memoir

Nine years ago, a book based on this blog felt like it was going to be an easy project. A month ago, the book was finally published, in a form that bore practically no relationship to where I’d started, and after a rigorous empirical test of its publication-worthiness.

When I began writing this blog, back in 2009, I barely knew what a blog was, and I knew even less about what readers of blogs—or books—about eating disorders might want, need, be lacking, or be harmed by. Because anorexia nervosa had wrecked the preceding ten years of my life, and because I was well into recovery from it, I wrote about anorexia from the perspective of someone excited and grateful and occasionally scared to be leaving it behind for good. And once the leaving-behind-for-good had happened, I kept writing about it because I remained interested in how eating disorders keep people wanting to be ill, how some people find their way out, and what all that can teach us about everything else in life.

And it turns out that this way of writing a blog about eating disorders—from a point well into recovery, where recovering is the focal point, and being-recovered is soon the standpoint—was a pretty good way to do it. Many of the internet’s now numerous eating disorder blogs, channels, and accounts are created and managed by people whose recovery remains a long-term work in progress. Many of them are nonetheless valuable, but many also do inadvertent harm. (Another category pays only lip service to “recovery” and does very deliberate harm.) And there are things that one can’t know about recovery until one has done it and come out the other side. In an understandable form of selection bias, most online content about eating disorders is created by people who are not yet recovered, while those who are tend to go on to do quite different things with their lives. This skew can create damaging distortions in conceptions about recovery, including supporting the myth that “once you’ve had an eating disorder you’ll always have issues around food”. Countering the imbalance is another reason why I keep this blog up, more than a decade since I recovered.

Of course, I’ve made mistakes with this blog, and I learned a lot as I went along. As my understanding of other people’s eating disorder experiences grew, I changed some things about how I wrote. One simple example is that at some point I went back and blanked out all the bodyweight details I’d given in previous posts. (I kept in some references to BMI, because although it’s a deeply limited metric [e.g. Nuttall, 2015], it does also give you some predictive power, especially where both fat and lean tissue have been depleted by malnutrition.) The blog became steadily less autobiographical, and I started incorporating into my posts more of what I learned about the ways in which my experience was and wasn’t typical. I grew more confident in pinpointing the specific sticking points worth exploring in depth to help readers find their own ways through them.

But what works in a blog doesn’t necessarily make for a good book. As I tackled this supposedly easy book project, nothing seemed to be working. Blog posts merely pasted together didn’t feel like a book; blog posts from different phases in my recovery and post-recovery clearly needed some kind of tying together; but adding some narrative connecting sections made it feel a mess. And so, bit by bit, I found myself writing a not-very-blog-based memoir, almost without realizing it. And then, because I’d spent the past five years doing research showing just how unhelpful—or rather, actively harmful—many people who read ED narratives find them (Troscianko, 2018; or see my blog post here), I realized I had a problem. What if this book was just as bad?

I’d done all I could to let my decision-making for the book be infused with what I’d learned from writing the blog, from corresponding with readers, from working with individuals in recovery, and from doing the reading-related research. The two most significant writerly decisions in this respect were (1) devoting a large proportion of the story to the recovery phase and (2) adopting a dialogue format.

• The illness-to-recovery ratio. From the first page, the characters in the book are asking difficult questions about being ill and relapsing and getting better, and by the third chapter it’s all about the reasons to recover and what might be ways to get started, and then the rest of the seven chapters are about doing it. So this is already a big difference from (and I caricature only slightly) the type of memoir where 250 pages of becoming and being ill are followed—or sometimes not followed!—by an unconvincing coda to the effect that “then I got therapy and got my life back”.
• Dialogue form. This seemed to offer a range of advantages too. To begin with, the stuck, doubting, fearing, voice is asking fatalistic “why change?” questions, and the no-nonsense, impatient, trusting, hopeful voice is always coming back with “why not?” ones; and the second is trying curiously to find out what’s really going for the first, and the first wonders why on the earth the second is so confident. The first benefit I noticed was that doing it this way let me avoid having to adopt a single authoritative voice, which had been feeling too presumptuous and too simplistic to chart such a profound changing of mind. Then I realized that it might also be a rather good way of letting the anorexic perspective be voiced but without letting it be all there is. This in turn could be a good way to forestall the kinds of damage that my research had suggested are so widespread, most of which seem to take shape via the kind of immersion in an anorexic way of thinking. As I discussed this style with other people, more potential upsides came to light. For example, it might help readers without personal experience of anorexia understand its weirdnesses—because the kind of scepticism they might voice is given continual right of reply, too, so the whole conceptual and behavioural architecture of anorexia gets thoroughly unpacked. It might be a form that invites or requires more autonomy of the reader, because it doesn’t have a “this is the right answer” structure to sit back into. And as part of that, it could be a context for practising separating out the illness voice from the voice of reason, which for many individuals is a crucial part of getting well.

But this was all “might” and “could”; all these benefits were hypothetical. Some of them had been very real to me as a writer, but who knew how readers other than me would respond. I realized that if I was honest with myself, I had no idea. And soon after that, I knew that it would be ethically irresponsible to go ahead and publish the book pretending that I did, or just hoping for the best. What’s the point in carrying out research if it changes nothing about how you do anything else?

In the second post in this series, I’ll describe what I decided to do.