Nonconformist Coping Strategies in Treatment and Prevention

This post is part 5 in a series.

In this series, I’ve explored the interactions between institutionalized drabness and loss of personal agency in mental healthcare today, using eating disorders as a test case. The two-tone thread that links them is the presence or absence of the individual as “the master of [their] fate, the captain of [their] soul”. In part 3 of this series I talked about treatment, and in part 4 I talked about prevention. Here I’d like to conclude by connecting the dots between the two and opening up to a different view of risks and benefits for eating disorder care and beyond.

My sense is that the invitation to design coping strategies that for oneself alone strike an optimal risk/benefit balance could lead to some pretty existentially profound creativity in children and teenagers—and the rest of us. And the same practices could be involved in the healing as well as the prevention. After all, a large part of recovery from an eating disorder (as for any addiction-involving illness) is always the discovery of alternative ways of coping with a difficult world that do less damage than the eating-disordered ways.

If running is the only good way you’ve ever found to relieve stress, for instance, and it’s become clear to you that it now does more harm than good, then you’ll benefit from some constructive reflection and experimentation with what in my nautically themed post on “8 Ways of Responding to Stress” I called things like “navigation” (e.g. the boundary between sensible stress prevention and fearful avoidance), “the happy routines of the voyage” (all the day-to-day habits that keep things ticking over nicely), and “maintenance” (the less frequent and less pleasurable “I don’t love it but it works” tactics). And maybe you’ll discover that by changing up your morning routine or that reliably stressful aspect of your job, you depend radically less on evening runs, to the point where they maybe even drop out of your life altogether—and you find other pleasures to give the time and energy that running once monopolized.

Imagine that at any point in your life, you receive non-judgmental support to discover the areas of experience-space that you want and need to hang out in—for pleasure, for stability, for comfort, for recuperation, for adventure, for inspiration—and that you’re then helped to discover the specific practical kinds of strategy that will let you do so. Many personal disasters might thus be averted when we think “Life feels unbearable right now, so let me try x”—where x is selected nearly blind, at the mercy of our genes, our peers, and our past defaults.

My predictions are only predictions, of course—and we may or may not ever get to test them. The ethics approvals for this sort of experiential experimenting would certainly be tricky! In the spheres of both recovery and prevention, after all, such connections between mental healthcare and life design would be an implicit rejection of the old medical tenet “First do no harm.” The point would not be to try to standardize away population-level risk; it would be to help individuals to meaningfully evaluate personal risks and benefits and act accordingly.

This type of approach would be founded on the fact that life cannot help but be full of harm (was it Schopenhauer who called life a constant process of dying?), and that trying thoughtfully to do less harm than the naturally encountered alternatives is a good enough baseline. (One, incidentally, that I’ve used in my research on the health-related effects of reading literature: No complex text is going to be harmless, but the conditions of experimentally investigated reading can be set up to be less gratuitously risky than ordinary life.) And ultimately, this approach would be a recognition that humans always have wanted many things that reduce their objectively measurable physical health and their potential lifespan, and that they always will.

I wonder what else would change if we dared to try a less conformist kind of care, aimed at nurturing a less conformist kind of health. I’ve made a case centred on eating disorders, and I think they’re a great place to start for a few reasons:

1. because how we eat and move permeates our bodies and our days so entirely;
2. because current protocols are failing so many people so miserably, at both treatment and prevention stages;
3. because recovery from an eating disorder, especially a restrictive one, is always a countercultural process: involving actively refusing the “eat less exercise more” messages that saturate popular culture, and instead deliberately letting one’s body get heavier and fatter (if it needs to) by resisting workouts, prioritizing fatty sugary foods, and giving hunger the benefit of the doubt.

This third reason helps explain the second: Many eating disorder treatment protocols are infused unreflectively with diet culture (e.g. in the form of “healthy eating” recommendations and bodyweight targets) so that they effectively prop up the disordered ways of being rather than demolishing them. No one can recover from anorexia with recommended serving sizes and macro tracking.

Similar arguments against the predictable paternalism of “this is how to be healthy” advice could be made for many other kinds of health and illness that span the boundaries between mental, behavioural, and physical. And nonconformist versions of both health and care have the potential, I think, to let us experience life-giving intensity in things that for us personally are not very likely to be the route to the drudgery of serious addiction and illness.

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We might, by this sort of route, end up likelier to laugh at what my mother, scared and frustrated by my years-long refusal to eat enough to be well, once called “the ridiculing laughter, the liberating laughter, of the person who says it’s all rubbish and remembers how to eat what they feel like again.” The kind of laughter that is made possible by being well, and that also frees us to become well. The kind that we rarely encounter in the mental healthcare world today, and that maybe—along with the expletive, the weird idea, the provocative question, the unheard-of invitation—we one day could.