What Can't Be Regulated Gets Controlled
Part one: on eating disorders, dissociation, and why the symptom isn't a choice
Anyone who has loved someone with an eating disorder has probably asked some version of the question, out loud or silently: why don't you just eat?
The psychoanalyst Philip Bromberg has an answer I find more useful than any other I've come across. You're asking the wrong self.
The symptom isn't a malfunction
Bromberg argues that what we call symptoms often aren't symptoms at all. They are "functional, adaptive, and, at certain moments, vital to survival."
What looks like pathology is a split-off part of a person doing a job that once kept them alive. When that part takes over, it doesn't feel like something they are doing, because it isn't their whole self acting. It's one piece of them taking the stage.
This is what dissociation is for. It lets the mind avoid holding two incompatible ways of relating in a single state of consciousness. "I need this person" and "this person hurts me" can't comfortably live in the same moment, so the mind files them in separate rooms. Only one has to be true at a time.
Bromberg is clear that this isn't a learned trick or a character flaw. He compares it to the instinctive freeze of an animal facing a predator. Trauma threatens a person's sense that I am still me, and dissociation is the automatic defense against that threat. It's wired in.
A self with its own point of view
Bromberg describes anorexia as "a hypnoidally isolated complex of physiological events, fears, movements, sensations and ideas" that work together as "a separate center of attention." It's a whole bundle of body reactions, rules, and beliefs walled off into something close to its own point of view. When it decides it's needed, it takes control of the entire personality.
That's why the disorder doesn't feel like a decision. It wasn't made by the whole person, so the whole person can't simply unmake it.
There's a hopeful side to this, though. Because that part is coherent, it can be spoken to directly. It has reasons. It will tell you what it's afraid of, if someone asks it instead of arguing with it.
Where it starts
Bromberg traces a lot of adult suffering back to infancy. A baby can't calm its own body. It needs a caregiver to help, and through repetition it learns something crucial: when connection breaks, it comes back. The parent gets distracted or frustrated, and then returns. Ruptures get repaired.
Without enough of that experience, a child is left managing overwhelming states alone, with no evidence that broken connection can be mended. Bromberg calls much adult psychopathology "the end result of the prolonged necessity of an infant to control physiologic and affective states while lacking an experience of human relatedness and trust in the potential for reparation."
The key word there is control.
Regulation versus control
Bromberg describes someone "enslaved by her felt inability to contain desire as a regulatable affect," and then: "What cannot be regulated must be controlled, by total renunciation if necessary."
Regulating a feeling means letting yourself have it at a manageable level. I'm hungry, I'll eat some, that's enough. Controlling a feeling means overpowering it so it never gets a chance to exist.
If you don't trust that you can hold hunger or wanting without being swept away, eliminating it can feel like the only safe option. It isn't vanity, and it isn't stubbornness. It's what a person does when the dial between "none" and "too much" was never installed.
Seen this way, anorexia is control standing in for a regulation that was never learned.
What I keep wondering is whether that regulation can be learned later, and from whom. A baby learns it from a caregiver who keeps coming back. An adult who never got that has to find the evidence somewhere else, and Bromberg is clear it won't come from willpower. That's where the second half of his argument begins.
