The enigma called ‘High-Functioning Anorexia’

The enigma called ‘High-Functioning Anorexia’

In the late summer of 2017, when I unknowingly plunged back into anorexia, I was trying to live as a freelance translator. I’d just left the publishing company where I’d worked as an editor for a year and a half. In other words, I had stopped the office worker’s routine – getting up early, going to work, squeezing my brain and body to produce the best work possible, and returning home. Now, I spent whole days alone in a tiny, rented house.

Upon quitting the publishing company, I resolved to write my own book but soon found myself unable to finish translating by the deadline, let alone write a book.

I couldn’t sit at a desk for any length of time, because I suffered from extreme fatigue of unknown cause and strange leg joint pain. I tried many things to alleviate such distress. I bought a soft folding easy chair, a wooden shower brush and herbal bath products, and bottles of nutritional supplements. Nothing helped.

Misinterpreting the cause of weight loss

I couldn’t immediately create income from the translation work, my bank account was emptying, the deadline loomed, and I became weaker and weaker. One day, my then-psychiatrist sighed and asked, “Could your decision to leave the publishing projects be responsible for this?”  I couldn’t understand what he said.
“For what?” I asked.
“I mean, are you starving yourself again out of the frustration that you had to quit the job?” he said.
“No.” I thought his reasoning was so ridiculous he must be joking. “I’m not sad nor disappointed that I had to quit the job,” I almost protested, revealing irritability. “Why would I stop eating simply because I chose to quit my job?”
What irritated me the most was the psychiatrist’s belief that my illness stemmed solely from a deliberate pursuit. He believed I was engaging in this behaviour due to emotional immaturity, rendering me incapable of seeking healthier ways to express my frustration and despair. Was my illness so straightforward? Was anorexia such an easily defined phenomenon?

The heightened awareness known as interoception is often accompanied by discomfort or fear. 

To be fair, I could understand my psychiatrist’s perspective. He was one of those pitiful, disillusioned, and burnt-out, middle-aged psychiatrists whose unfulfilled dream was to be a writer or an artist. He showed keen interest in my work, my writing, the books I was reading, and more. He surprised me by confessing he envied my job, and we regularly discussed co-authoring a book or brainstorming titles for his upcoming works.
Often, our therapy session became a kind of impromptu editorial meeting which we both enjoyed. One time I suggested my psychiatrist set up his own publishing office, referring to Dulwich Centre Publications, founded in Australia in 1984. Eventually, he did establish it and soon published several trauma and EMDR (Eye Movement Desensitisation and Reprocessing) translations.

Feeling isolated at work led to a downward spiral

Having transitioned from a copywriter to an editor, I had been entrusted by the company’s founder-president to oversee its new imprint. I had worked hard for 18 months to launch six books into the world. But I felt severely isolated at work – receiving no help from the marketing team, for example. I had to do everything from editing to marketing – and was exhausted from continuously compromising my own values for public taste. Friction developed between myself and the president, who was accustomed to profiting largely from test prep books and grew disillusioned with the liberal arts books I championed.
Ultimately, I relinquished my position, intending to focus on my own writing and earn a living as a freelance translator. Health concerns were also emerging. Worsening irritable bowel syndrome and side effects of overused laxatives that I took nightly affected my digestion. For months until I departed from the publishing house, I lived on small bags of wasabi-flavoured potato sticks and about six cans of zero-calorie energy drinks during working hours. By midday, I experienced abdominal bloating and cramping. These discomforts quashed my appetite.
From the moment I ceased going to work, I succumbed to the familiar, persistent, and acute discomforts, mostly related to my gastrointestinal functioning. At first, I didn’t feel like eating a proper meal. Instead, I continued snacking throughout the day. Predictably, the resulting painful heaviness and disgusting fullness in my stomach drove me to vomit. Vicious mini-cycles unfolded – compulsive snacking punctuated by episodes of vomiting – monopolizing my time. I rapidly grew weaker, and the enigmatic fatigue and pain further incapacitated me.

This was not mere dieting. What can I call it instead?

One day, my psychiatrist said, “You look like you lost weight.” The possibility of weight loss finally occurred to me, and I ordered a cheap electronic scale that day. Surprisingly, I found my weight had plummeted. Did that inject a kind of joy in me? Or was it horror? No, I can’t name it yet. However, the moment I read the number on the scale, the thought that “the number mustn’t increase” became a categorical imperative. The number became the ugliest and most sickening number in the world, and I felt compelled to try everything to eradicate it – that deafening sound, that afterimage, that flashback.
From then on, I consciously tried to reduce my daily calorie intake. This led to more frequent binging/purging episodes, and my daily life collapsed uncontrollably. Now unemployed, I had to work harder to cope with monthly living expenses. I tried to complete a project as fast as possible to receive timely payment. During this period, I focused on translating the CIA’s pamphlet about sabotage tactics distributed during WWII. The pamphlet outlined various strategies for undermining enemy organizations’ productivity, even suggesting placing heaps of paper near potential fire-starting locations as a last-minute setup. I was tasked with translating this text within a short timeframe, but I was inadvertently sabotaging myself.
Subsequently, I reengaged with the meal support program, colloquially known as “Supervised Table,” with Ms Ahn. Eventually, I was allowed to almost “reside” there, having lunch at the supervised table, then working on the same table with my laptop, translating the CIA pamphlet, and again having dinner as part of the program, thanks to Ms Ahn’s compassionate consideration. Sadly, the stalled progress of my translation project didn’t recover and, as I confessed in my memoir, Swallowing Practice, I could no longer maintain the façade of being a “high-functioning” person with anorexia.

If it wasn’t a lie that she said she just liked to work…

There is a historical anecdote about Isaac Newton in his 20s. During a pandemic-related closure of Cambridge University, he returned to his parents’ home and dedicated 18-19 hours daily to studying, isolating himself from other pursuits. No one suggests that his intensive study regimen resulted from a desire to push himself to an early death or that he harboured resentment toward his own well-being.
I, too, am driven by a fervent curiosity, a thirst for deeper understanding and self-awareness, and often wish for enough energy to endure the heavy-lifting tasks for enlightenment. I’m not apt to care for myself, but this is more a matter of neglect than abuse. As for self-love, I think it, too, seems contaminated by neoliberalism-like work ethics. Maybe people susceptible to anorexia tend to feel disgusted at the thought of self-pity more readily than of pushing themselves through.
I recall watching a television interview with a young woman who had achieved a diverse and successful career trajectory – studying art at university, working at a foreign bank, becoming an international flight attendant, passing the bar exam to become a lawyer, and eventually transitioning to a police officer. During her bar exam preparation months, she consciously restricted her food intake to minimize sleepiness and reduce time spent in the bathroom. Despite the inevitable side effects such as hair loss, her health compromise was temporary.

I wondered whether her spartan months could be classified as anorexia.

Years ago, I stumbled upon an episode of an old American TV show on YouTube. It depicted a medical student grappling with severe anorexia, alongside her family’s struggles. I recall her parents describing her as “brilliant, akin to Einstein.” Scepticism arose regarding their claim, given the common tendency for Americans to exaggerate to impress or self-promote. As the show’s advisory panel concluded that the family’s dangerous interdependence hindered the daughter’s recovery – suggesting that the parents were deceived by their daughter – any of her ventures seemed suspect.

The show’s focus on the anorexic patient as the sole target for treatment and intervention solutions rendered any ambitious pursuits as mere distractions or pretences to deflect attention from her problematic behaviour.

Giving rein to the patient’s capacity to change

As experienced clinicians would likely concur, the remarkable determination and resilience exhibited by some people with anorexia can serve as a potent catalyst for personal transformation and change within their environment, surpassing the impact of external influences.
Recently, a fearless activist for disabled rights, who is also a mother, invited me to discuss her young daughter’s struggle with anorexia. This determined young girl’s resolve was unyielding, and she adamantly refused to acknowledge her illness or the necessity for immediate treatment. A relentless psychological battle ensued between the mother and daughter, with the girl opting not to visit Ms Ahn’s clinic as I had recommended.
At first, I was disheartened, plagued by worries in advance. I had limited means of assistance, so I sent her several books as a present with a note, saying, “I asked Ms Hong for your address because I wanted to befriend you. I’m an ordinary office worker, albeit one striving to amplify the patients’ voices and reform the care system. The inspiration drawn from your and Ms Hong’s efforts has been invaluable to me. Thank you! I hope one day we can work together. I encourage you to conserve your strength for the day we meet.”

If you see someone with anorexia trying to effect change, support her

Shortly after that, a one-day event called Girls on Wheels, organised by Ms Hong, was held at Heyground, the co-working space for social ventures in eastern Seoul. This time, her daughter joined the project as a reception staff. Accomplished women mentors with disabilities, undeterred by their conditions, took the stage to share their stories. Although I couldn’t attend, I hoped their narratives would imbue the young girl with renewed courage.
And now? Well, I don’t know what happened to the mother and daughter afterwards, but it seems they are doing well, that the girl’s condition has improved. The women’s societal critiques and their unwavering activism remain unchanged. They thrive, steadfast and intact — a testament to the folly of my needless worry. Who truly fretted over whom? How ridiculous!
If you see a woman trying to effect change, refusing to stay silent in the status quo, please support her. Help in the same way as monitoring a waterway, ready to offer guidance when needed. Maintain this conviction, in the rooted belief that the woman’s drive will manifest as a force for transformation.