I’m always saying that anorexics are too ill to have much of sense of solidarity. We don’t have the energy to form self-help groups. BEAT doesn’t seem to be staffed by acute sufferers. So I was doubly affected by a recent edition of The Untold on Radio 4, called Getting to Grips with Anorexia. It was a poignant story as “Maya” and her family battled against the disease while also preparing for her A levels. The thing is, I felt deep sympathy for Maya’s family, and empathy for Maya herself! That must mean I’m getting better!
When I first realised I was ill I’d have been surprised to find myself identifying so closely with 17 and 18-year-old girls. But one of the strangest aspects of anorexia is the way it manifests itself in such predictable, almost scripted, ways. Abi once gave me a standard printed NHS questionnaire about my thoughts and feelings. The answer to the first question had already been filled in as an example and it described exactly how I experienced and thought of my condition. That was a humbling moment.
Maya’s experience seemed to have quite a lot in common with mine. For a start, she spoke in the typically hoarse, flat voice of the anorexic running on empty. My own voice very suddenly set into a strange, forced shouty whisper, as if my vocal chords had gone into spasm. When I put on some weight my voice went back to normal. I still have no idea why that happened.
Then there’s the way the illness developed. She says “It started off being about nutrition; what’s healthy. Then it started being about food groups, so I want to cut down on complex carbohydrates or saturated fats, and then it started being about calories”. My own experience mirrors Maya’s, here, step for step. When her mother says “I just noticed she was getting more and more edgy around mealtimes; more and more controlling over what she wanted to eat”, it could have been my wife, Jo.
Even more interesting, I think, is how similar my anorexic thoughts were to Maya’s. We both saw our unhealthy state as temporary, partly because we had arranged things so that we could only think as far as the next meal. Maya said that she saw her low weight as less dangerous than everybody else did because “my recovery is inevitable”. That’s exactly it. – it’s just how you are at the moment – so, therefore, it’s nothing to worry about. If you dip down to a dangerous weight, you’ll soon come up again.
Maya also responds to her treatment in a similar way to me. She says “I feel quite pressured to make progress”. Her NHS eating plan says she has to put on at least 500 grams a week, which causes her to pause and almost audibly gulp. The weight gain they force on you seems horribly suffocating and panic-inducing. When you begin treatment, the urgency and speed with which the eating disorders team want you to start eating is startling. You want to cry out “Wait! I’m not ready!”; you’re terrified of losing control. In the documentary, you hear Maya arguing in a shrill, panicky tone with her mother about what she’s going to eat for dinner, trying to wrest back control.
Maya’s response to this, like mine, seems to be to find ways of compensating for any increased calorie intake by finding ways of burning off those calories through exercise. She tells us in her audio diary that she’s going to the park to meet her friends and possibly have an ice-cream (though she says this with the shy tones of someone who is being dishonest, to my ears) and that she’s going to run to make sure she doesn’t add any calories. Later on she tells us “I had three pieces of toast and Nutella and in the 20 minutes that I should have been getting ready for school I was just panicking and thinking of all the ways I could use as much energy as possible” and “I’ve had to wake up early to exercise in my room”. This is exactly like me. You sift through every part of your day, looking for the minutest possible scrap of exercise to make up for any increased calorie intake, like you’re panning for gold. I remember going to London for somebody’s birthday treat, and while the rest of the family stood on the escalators on the underground, happily savouring their London experience, I trudged down them and waited at the bottom, purely for the couple of calories I hoped to burn off. Anorexia gets soaked up into all your experiences. As Maya’s mother says, “anorexia… creeps in. It finds little cracks”.
On the other hand, we want to please people. We want to get better to show our families that we love them and that we know we are upsetting them, and this means we try to say, and we try to mean, what you want to hear. While acting in this way, Maya still says she feels really confident about her recovery. A few months later she is telling her mother her “mind-set is totally different” but the mother thinks she’s throwing her sandwiches away. Maya admits “I’ve been telling my parents that I’ve been gaining more weight than I have”.
Then there’s the confused response to a treatment that seems to be an indulgence, a form of surrender. When you eat your yummy food, it tastes lovely, something medicine should not, and you feel that you’ve weakly given in to your hunger, the intense desire to eat, so every success feels like failure. Maya complains “I don’t feel any achievement for eating a bowl of pasta. I feel shit for eating a bowl of pasta”.
She also, like me, needs to eat separately from people who have too much invested in her recovery and who may scrutinise her too intently as she addresses the difficult problem of eating. In Maya’s case she can’t eat with her father; in my case it’s my children, who I fear may end up modelling my behaviour and attitudes to food. Actually, I’d always prefer to eat either alone or just with Jo. At work, I never eat in the staff room. I sometimes end up locking myself in a cubicle in the loo – not a very appetising atmosphere!
Of course, there’s the damage you do to your family relationships: the guilt, and the way you can’t express that guilt. Maya says, apparently without emotion, “I’m obviously so distressed by the symptoms of the illness that I don’t actually think about my family”. Understandably this admission isn’t enough for them. Her suffering family want clearly expressed guilt: Her 14-year-old brother says, wearily, “all we talk about is food” and “I think she knows a little bit but she doesn’t really know to the full extent [what she’s doing to him]; she doesn’t really care”. Her father says “she was friendly; she was loving; we used to enjoy each other’s company; we used to go out and eat; she had a very good friendship group at the school; she had every opportunity”. He also mentions watching her “change into this monster” Her mother says “No one wants to see us – she’s ruined…”
Poor Maya! I think her family don’t fully appreciate the duality of mind I’ve talked about before. You can really, honestly, understand what you’re doing and why it is wrong and unfair, and still actively pursue the behaviour. In the documentary she made with her father, Maddy Austin said they’d had screaming rows about how she was tearing the family apart and “that absolutely broke my heart”. Mark Austin replied “Well, it didn’t break your heart enough to stop and that is the problem” (Does this reveal a masculine, punitive conception of parenting?) People tend to say “Well, if you know it’s wrong and you really want to stop, why don’t you just stop?”, not realising how you can have two totally different, conflicting agendas existing in your brain simultaneously. These two creatures are locked in a mortal struggle that completely fills your head through every waking hour. But one of them is struggling unceasingly for you, dearest family, to get back to you and make it alright. The lying and cheating is caused by a genuine desire to commit to, and do, the right thing while the anorexia just ploughs on regardless. The misery, guilt and embarrassment this causes is further compounded by people you love being unable to understand it. They think you’ve reconciled yourself to being a nasty person, whereas, your whole mind is an unreconciled battlefield: Maya’s brother talks about her “arguing and shouting” when I think she’s probably just manifesting distress.
In this respect, I think teenagers have it worse than me. Because they are still in their parents’ charge, they have more to resist and can focus their resistance on their parents, who feel obliged to administer the recovery plan. This may speed up recovery, but must massively increase the pressure on the kid. Unfortunately, it probably feeds into existing teenage conflicts and desires for independence, so that anorexic panic is misdiagnosed as argumentative, teenage rebellion.
There’s also the hormonal issues. When you starve your brain, it starts to malfunction. That’s why you go so weird. As an adult, once I started to get better, the madness of anorexic thinking became starkly apparent. But teenagers are half mad with hormonal imbalances anyway, so it must be difficult to work out what is anorexic thinking and what is teenage angst. Maddy Austin talks about becoming withdrawn and isolated because that was the best way to deal with “all these really horrible emotions that were going on inside” but I suspect those emotions were actually generated by the anorexia itself.