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Dreaming

Sleep and Dreaming in Anorexia

Ending the year with a few thoughts on the dreamworld of disordered eating

A friend asked me a couple of months ago whether I’d ever dreamt about anorexia since getting better, and I said no. I was surprised at the question, and then at my answer. It seems odd that one’s life could be defined by something for so long and it never feature in one’s dream life thereafter.

There’s no scientific consensus on the precise function of dreaming. They may just be evolutionary byproducts with no adaptive function of their own – perhaps resulting from the attempt to make sense of random neural activity beginning in the brainstem. On the other hand, they may serve useful purposes: theories have been proposed ranging from memory consolidation and conceptual integration to modification of mental schemas, threat simulation, direct problem-solving, and evolutionary motivation.

Research on dreaming is difficult, and research on dreaming in the context of mental illness even more so. With the usual caveats about the biases introduced by any experimental method, and by self-report itself, as well as the potential effects of psychoactive medication, some findings are emerging on dreams dreamt by people with eating disorders (reviewed in Skancke et al. 2014; PDF here). In general, these point to clear continuities between the form and content of the dream and the waking conditions shaped by disordered eating. For example, dreamers with eating disorders dream more about food than healthy controls (bulimics possibly more so than anorexics); anorexics are more likely to dream about themselves as younger (possibly reflecting feelings of immaturity – or a desire to look ‘better’), and with bodily distortions (like a large tummy). There are contradictory findings when it comes to the emotional qualities or their absence in dreams during eating disorders – but generally there seem to be more negative and fewer positive emotions dreamt about in eating-disorder sufferers than controls, as well as fewer dreams in colour among anorexics. Other studies found that ED sufferers are more likely to dream about being the objects of violence, and to experience fewer feelings of hostility towards others than controls in their dreams. Other scenarios that may be more likely among those with eating disorders include anger, self-hate, a sense of impending doom at the end of the dream, ineffectiveness or a sense of being unable to succeed, an inability to self-nourish being attacked, and a sense of being watched, controlled, or judged by others. Those with anorexia may also be more likely to report a lack of context in their dreams, and to report dreams in the present tense, and without a linear structure – indications, perhaps, of a generally heightened sense of self-doubt, even about this most private and unfalsifiable of experiences.

I don’t have any clear memories of dreams I had while I was ill. As the illness worsened, sleeping felt more and more like being dead: an exhausted black-out that lasted from the moment of finally letting myself lie down to the moment my alarm roused me, sometimes with a loo visit somewhere in the middle. In general people with anorexia report disturbed sleep (Lauer and Krieg 2004), but that was never a problem for me, perhaps because I finished every day with a large amount of chocolate that created a sugar crash perfectly timed to let me sleep. If I did dream, I suppose anorexia was simply the normality that defined the dream context, rather than drawing attention to itself as something problematic.

I certainly don’t remember any dreams that I experienced as directly relevant to anorexia or recovery. When I did dream, I dreamt about other things: between taking my A-levels (at the end of secondary school) and finding out my results, I dreamt about having failed them, before my final undergrad exam I dreamt all kinds of unsettling things, and between Finals and getting the results I wrote in my diary that I’d dreamt of ‘assorted long-lost males’ and of being ‘awarded half a million pounds for my Finals result’ (21.7.04). Most often, when I dreamt, it was about men. I dreamt of men who were mixtures of real ones I knew and loved or desired; I dreamt of the partner I gradually split up from as my anorexia worsened, dreaming that he’d told me he loved me again and that I wanted him uncomplicatedly; I dreamt of symbolic losing and finding of rings. I dreaded dreaming of him: ‘Too many vodka-and-diet-Cokes might help me sleep, but I sense they’ll make me dream too. And what is there to dream of but him, the impossibility of forgetting him, the impossibility of the past and the present and the future’ (30.12.02). When it was more or less over between us, and I was far away in Germany, I dreamt of sex with people I didn’t fancy, with ‘the most amusingly archaic condoms with metal rings round the open end’ (25.03.03). I also became gradually aware of dreaming in German, or even bilingually, and felt a new German Emily emerging from the dreams. I fell in love with a German man, and the night before the first happiest day we spent together dreamt ‘strange dreams of eggs and summer snow’ (13.4.03). But anorexia turned everything sour, and the summer snow was soon no more real than the Easter eggs we painted together.

In retrospect, though, there were some dreams I could have interpreted as my mind’s attempts to make sense of anorexia and its effects. In one, I dreamt of my more-or-less ex in a way incompatible with waking reality: ‘Suddenly can’t bear these dreams any more, their immediacy, their conviction, their happiness which metamorphoses into misery as I wake’ (27.03.03). Waking up in the morning (or, by the later years, the afternoon) was always the most awful part of the day, with the longest time still to survive until eating, and so much still to do with so little energy. But those dreams of happiness could maybe, had I chosen to read them that way, have told me something I needed to be reminded of about the possibility of my happiness but its impossibility in my waking life.

One other dream I wrote about in my diary, in the weeks during the summer after Finals as I sat in my bedroom at my mother’s house writing my interminable autobiography of an illness, springs to mind here too. Still I was dreaming of my no-longer partner: ‘An awful night. And a dream of him. A cold train – snow – but Lancer [the boat I lived on] too – and skiing – he asking me why I’m so cheerful, and saying it’s never really been about him, has it? – and me saying of course, yes, look, and showing him writings of mine – him is always him, whatever other male proper nouns might be floating around – he is always the absolute. It’s too much. Dreaming of him as well as thinking, always, of him (26.07.04).

In the diary entry I seem preoccupied with proving to him that he did matter to me, more than anyone, but more interesting now seems the idea that our relationship wasn’t really about him, which is something I did reflect on a lot in my more lucid moments: knowing that longing for him was easier for me than being with him, admitting that I deferred time with him as I did food, until I’d properly earned it, and so on. But I never quite got to the point of realising that anorexia meant that nothing could really ever be about someone else: that I had no real capacity any more for the kind of empathy and closeness that love depends on; that my moods and mental world were insulated by starvation and obsessiveness from anything anyone else might do or say. I suppose I just wasn’t quite in a position to see that, clear-sighted as I thought I was – and really was – about my illness in many other respects.

Now that psychology has for the most part moved beyond Freud, the assumption that the only way to engage with dreams is to interpret them as one-to-one symbolic representations of repressed subconscious drives can be thrown out with the rest of the psychoanalytic baggage. But if we cast those false simplicities aside, it’s hard to know quite how to treat them.

As someone with too much literary training for her own good, it’s easy to find elaborate meanings in pretty much any scenario anyone can dream up – but the skepticism that comes from reading too many far-fetched works of literary exegesis kicks in here too, and tells me that, well, that’s just one reading, probably an over-thought one, and maybe it’s all just random neural junk.

Even if one does decide to assume that the dream form and content have meaning, the danger of over-thinking interpretations is acute, again when it comes to the matter of symbolism or metaphor. Things that happen in dreams, like things that happen in books, are themselves as well as having the potential to represent other things. They need to be treated as legitimate in themselves as well as possibly denoting something else – or some balance struck between the two. And that can be frightening as well as difficult. As Hillman and McLean (1997) put it:

Animating the image—that is the task today. No longer is it a question of symbolic contents of dreams . . . both Freud and Jung made a move that we no longer want to repeat. They both translated (dream) images into crystallized symbolic meanings. They didn’t let what appeared express itself enough, but moved toward satisfying the rationalizing—and often frightened—dayworld mind. ‘This means that.’ (p. 29; cited in Knudson 2006; PDF here).

The danger of interpreting too categorically is raised by one case study reported in the eating disorder and dreaming research (Knudson 2006). The 22-year-old anorexic Stephanie had recently withdrawn from therapy, and her weight was at a level that was becoming life-or-death critical. The dream felt so significant to her that she made contact again with her former therapist, and reported to her a dream in which the outside wall of her bedroom is missing and she sees a terrifying monster in the back yard. The monster jumps into her room and is ready to pounce; she knows it wants to eat her. Neither her father nor her mother can help. Her account of the dream ends thus:

I don’t feel weak but for some reason I just know my legs wouldn’t go as quickly as I need them to. I’m still frozen. And I know that if I keep thinking about what to do—whether to call my mother or to run — I am going to start to panic, because neither option is going to work. So I stand there . . . in limbo, knowing the only thing to do is to stare at the creature and not be afraid, even if I am. I have to deal with the monster, stare it down—because I can’t escape it. To get rid of it, I can’t be afraid. I start to turn toward it; and then, I wake up.

Knudson interviewed Stephanie several times as part of the dream research he was conducting, for which she volunteered her dream. As he presents her testimony, for Stephanie, the dream felt like an epiphany because she had felt her terror of the monster in an intensely embodied way in the dream – in a way that had made her realise that she still had emotions, still had physical feelings, and that therefore her body was not dead. She went on to make a seemingly successful recovery without professional support. She rejected her therapist’s help because the therapist immediately offered an interpretation that zeroed in on a single aspect of the dream, Stephanie’s precarious posture with one leg on the bed and one on the floor, and concluded that this represented her unstable psychological condition and that therefore the only valid reading was that she should return again to hospital for more inpatient treatment. The therapist was apparently unwilling to engage with any other aspects of the dream, or any other possible interpretations.

Of course, we have only Stephanie’s side of the story here, filtered through Knudson’s account – and this is only one person’s experience. Nonetheless, this is a helpful cautionary tale about what can happen when we focus on supposedly symbolic objects to the exclusion of experiences. Whether or not we can say of dreams what we might claim of mental images – that they always bear their interpretation within them, such that a cat simply is a cat if that’s what I know I’m imagining – the dreamer’s experience of what (s)he dreams does matter. It is one of the clues we must use when we try to make sense of what we dream: how did it seem to me, how did it make me feel?

As my recovery progressed, sleep stopped feeling like death, and felt more restful, and deep in a different way. I slept huge amounts – often more than ten hours a night and an afternoon nap of a couple of hours – but still I don’t remember dreaming being a very significant part of sleep. One thing I’d expect to be very common during recovery would be anxious dreams about either relapse or excessive weight gain or both, or simply about being ill again, but I don’t recall any such dreams.

Only in the last year or so have I started to wake up most nights with memories of having dreamt. Many of my dreams involve my dead father, with a half-and-half awareness that although he’s alive in my dream, he shouldn’t be, or something about him being with me is vaguely wrong. I’ve only had two dreams where that was not the case, and he was uncomplicatedly alive and well.

Oddly enough – or perhaps not so oddly, depending on how you look at it – in the month or six weeks after the conversation with my friend about my dearth of anorexic dreams, I had two. Or rather, I had two that were half about anorexia.

In the first, I was sitting at a boardroom table, on the opposite side from other people being given psychiatric advice. I wasn’t thinking of myself as one of them, but clearly I was there for a reason too, and I knew there was something wrong with me, and that that thing was anorexia, but didn’t explicitly acknowledge it – like that mental image you know is a cat but couldn’t report any concrete features of. Then there was an explosion in the sky-scraper opposite and everyone cowered under the table and the nearby potted plant for cover, and we all assumed it was a terrorist attack. And then there was a long sequence of me trying to load up my bicycle with all the things I could rescue (though I don’t think I was living in the building) – very reminiscent of the heavily laden way I always used to walk and cycle around while ill, which magically stopped when I got better. I woke while still stuck carrying things in some repetitive loop between the building foyer and the bike racks.

The other dream was much harder to keep a grasp on after waking. All I can still summon up now is a single scene without a narrative, of me in an underground network of caves and tunnels. I was standing in one of the caverns in front of a stall where two women were giving a speech about something they were selling. Again, anorexia was half there and half not; I had the feeling that what they were describing was centered on eating disorders, and that I was not a chance audience, but neither fact was explicitly given.

These dreams came a few nights apart, and they slightly unsettled me, since anorexia feels long ago now, and that conversation hadn’t felt salient enough to give rise to two dreams in close succession. On the other hand, they fell in the week between me writing my last post and posting it, and maybe they were speaking to the slight anxiety I felt about being honest about the fact that my life isn’t totally sorted when it comes to food, any more than it is in any other domain.

If you have an eating disorder now or have had one in the past, I’d love to hear about your experiences of dreaming, in illness, recovery, or beyond, and in particular whether your eating disorder ever seemed to be the primary subject matter of your dreams. I’d also be interested to know whether my experience of having (or at least remembering) fewer and fewer dreams as my illness progressed is atypical or not. I haven’t found any research to the effect that dreams become less frequent in long-term anorexia, but maybe it is in fact commonly observed.

I don’t really have any grand conclusions to offer here other than to say how lovely it generally seems to me now to have this rich dream life that was never there before. Sometimes it’s upsetting, sometimes beautiful, sometimes weird, often all three, but its richness feels like evidence to me that my mind and brain have the resources to devote to this part of life rather than saving every last scrap for the essence of survival. At this time of year in particular, the way they let me be close to my father again seems the most valuable gift of all. But whether they’re about him, or capsizing my narrow boat, or trying and failing to show off my squat technique in some giants’ theme park, they’re another part of being alive, and learning about myself and the world. Perhaps they’re all the more valuable a part for the fact that what exactly they teach is never quite clear cut.

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