About a year and a half ago, the New York Times ran this story by a mother whose baby girl Violet was born with a heart defect and who, as a result of complex treatments for that, ended up with another problem: she didn't eat.
You should read the whole story, because it is emotionally moving, intellectually sophisticated, and philosophically interesting. Basically, her daughter needed a temporary nasogastral feeding tube, and after that were various struggles to get her to eat. But she was so weak, she never could get more calories than she spent, and she grew to associate eating with pain and suffering. This aversion to eating was so severe that they had to continue with the tube.
Heartbreakingly, the tube intensified Violet's aversion to eating. Once a week it had to be changed; her parents had to hold her down while she screamed and cried and then they had to wait til she stopped to breath to try to get it down her throat. Horrible. Of course, after that, Violet didn't want anything near her mouth, ever. When Violet was around six months old, they put in a permanent tube directly into her stomach. As her mother says, "devastating." And also "a relief."
Not surprisingly, given modern medicine, Violet's story is common, and the essay discusses the various approaches experts take to try to reintroduce children to the feeling that eating is something they can and want to do. Many take a behavioral approach. Because a big part of "oral aversion" is the association between pain and food, a lot of this involves creating positive external associations with foods -- for example, associating successful eating with toys -- and reinforcement that eating is going to happen. When another child in treatment eats she gets rewarded; but when she spits out her food, the therapist feeds it back to her.
A slightly different approach involves trying to reconnect the child with the internal cues of hunger and pleasure. Of course, this is tricky and potentially dangerous, since you have to let the child feel hunger, which means you have to feed them, through the tube, less food than they need, which must be terrifying with a child whose health is already a bit shaky.
One of the interesting aspects of the latter approach is the idea that to associate food with pleasure, you have to let kids spit out food and not worry about it. Violet's mother describes how, when they were beginning, Violet would put a bit of food, and then eventually more food, into her mouth, and then -- instead of swallowing, she'd spit it all out. Frustrating! but the therapist says that spitting is an essential part of the process: it lets Violet know that she can spit it out, so it is safe to experiment with another bite.
The first time through, at this point in the story, I didn't really know how it was all going to turn out. Was Violet going to be able to eat? Before I got to the textual resolution of this question, I came across a photo accompanying the story. The photos before had all been of Violet with her tubes. But in this one, she had chocolate avocado pudding all over her face, with a huge smile because -- yes, she was eating it! The image brought tears to my eyes the first time, and then it did again an hour ago when I reread the story.
After getting Violet to disassociate food and pain and associate food with pleasure -- or, at least, curiosity -- they had to let Violet get hungrier and hungrier. But in the end, it worked. Like a month later, they're all out at a diner and Violet is scarfing down a grilled cheese sandwich.
This story came out in early 2016 but I think about it regularly, even now. Partly I guess it's because it's interesting and happy, which so few things are these days. But partly I think it's because it shows something important about human nature. That everything -- even something so seemingly straightforward as eating, transcends biology. Everything is social and environmental.
In some philosophy I was doing with a student recently we were talking about the idea of idealizing people as if they were "mushroom men" -- people who sprang from the earth as fully formed adults, ready to make decisions, form goals, and negotiate with others for what they need. This was in the context of talking about economics, where sometimes the metaphor is used to explicate models of economic rationality and exchange. But of course it's long been central to philosophy as well, for example in the contractarian and contractualist traditions in historical philosophers like Hobbes and, to a certain extent, in more contemporary ones like Rawls.
Like all idealizations, this one might work better in some contexts and worse in others, it might capture or obscure what we want to see in certain settings, it might be more or less of a misrepresentation depending on what we're using it for.
Still, I found the story a great reminder of how far from that we really are. It's not just that when we're small, we're temporarily unable to forage for food or work at jobs. It's also that everything we do -- even something like eating! -- depends on a fragile and contingent network of things happening and people who love us there to make sure those things work the way they're supposed to.