(What did you dream? It’s alright, we told you what to dream.)
I couldn’t tell you the exact train of events that led to me being diagnosed as anorexic. My memory has always been rubbish, something to do with my mild dyslexia, Jo says. By that point, however, everything had become vague and confusing, anyway. In my memory, I seem to wander listlessly through a series of familiar rooms, full of people; bemused by yammering, wittering voices, some of which were my own; challenged by awful, indeterminate crises, my exhausted dozing disturbed by fretful anxieties. I was a weakened swimmer being rolled under sandy breakers by turbid undercurrents and treacherous backwashes. (So to speak.) I kept tripping over and cracking my ribs or dropping things. Walking slowly down corridors, I would dribble to an exhausted halt and lean against the wall.
I think Jo insisted I went to see the doctor about my weight loss, “just to check”. I was weighed and admonished and sent for assessment by a series of quietly sympathetic women and men with ID badges saying things like CAMHS and MIND, who all asked me the same questions. Was I suicidal? – “Christ, no”, I’d quip, “Who has the energy for that sort of behaviour?”. And anyway, I was far too bewildered to feel sad. A GP told me, severely, that she was recommending me for treatment because I had children and she was concerned with the effect my behaviour was having on them. (Presumably if I was a bachelor I could starve, as far as she was concerned.) A beautiful young woman told me I was too thin for Cognitive Behavioural Therapy. Somebody said, sympathetically, “It’s a terrible thing…” then added, quickly, “…that you’ve done to yourself”
Then, at last, I met Abi, the Eating Disorders Expert-Lady, who zips madly around the whole county in a little red car, taking no nonsense from mumbling bull-shitters like me. She took one look and that was it: and she’d got the measure of me.
So now I’m a recovering anorexic, clutching the diagnosis like a talisman. Looking back, I’m pretty happy with my treatment by the NHS. They took their time working out what was wrong with me, but, then, so did I. Once they took me in hand, I never felt I was going to drop out of the system. Or maybe I did, but in the end, I did get looked after and I was never told that I wasn’t thin enough for treatment and should try harder, which seems to be the most common complaint from fellow sufferers. My experience doesn’t seem to be universal, though.
Maddy Austin, the daughter of the presenter Mark Austin, is an ex (or recovering?) anorexic. The pair of them have just made a documentary. (Channel 4: Wasting Away: The Truth about Anorexia,25th August 2017, I think). Like “Maya”, in the Radio 4 documentary, Maddy’s experience was oddly similar to mine. Her mother described the signs of her physical deterioration (“Cold, heart-rate very very slow, blue lips…Her skin broke down”), all of which I experienced. Mark Austin talks about the same sort of damage done to the family: “home became a battle zone…She became secretive, cunning and manipulative. Our relationship collapsed.” Mark also began to think of the condition as a baleful, autonomous creature who had possessed their daughter: “I wasn’t talking to Maddy; I was talking to this thing called anorexia”.
They are mostly concerned, however, with the inadequate and inconsistent response many sufferers experience, once they have been diagnosed as anorexic. The Austins seem to have done their research well and the documentary is full of useful stats, so we learn that “1.2 million people suffer from eating disorders in Britain… there’s a 16 month waiting list for treatment in many parts of the country…There are just 202 beds in the whole of the UK for children and young people with eating disorders…213 eating disorder patients have been sent out of area for treatment this year” (That’s private treatment, which the NHS pays for, presumably at a greater cost than its own services, because, confusingly, it can’t afford to provide the service itself.)
They paint a sorry picture of the help available from a chronically underfunded health service. As these figures show, there are far fewer beds than there are sufferers, and out-patient support is far too thin on the ground. All too often, anorexic outpatients seem to be abandoned once they hit an acceptable BMI, presumably as their overworked Eating Disorders team rushes off to the next crisis. Maddy and Mark talked to a woman whose daughter, Lydia, was discharged from Norfolk’s Eating disorders clinic once her BMI was normal. Actually, this is not quite so neglectful as you might think, because it’s starvation that makes your brain go truly mad, and, of course, actually kills you, so once you reach green band on the BMI scale, you begin to think more sensibly about eating. This gives the poor old over-stretched NHS the chance to put you down as a success, discharge you, rush on to the next acutely underweight teenager, and hope for the best. Unfortunately, without support, Lydia went on to commit suicide.
I think the problem is that anorexia is a psychological disorder. It presumably has underlying psychological causes that need to be addressed at length. Nowadays tax-payer funded services are expected to have explicit, measurable targets, but, with mental health problems, it’s difficult to precisely define when, if ever, the patient is completely better and you can leave them to their own devices. Most people would probably like to have occasional therapy for the rest of their lives. Moreover, Mental health treatment seems very vague and uncertain. It’s not clear exactly how or why the brain goes doolally or how to set it right again. Talking therapies feel beneficial, but it’s difficult to measure the impact of a conversation. So it’s difficult to be sure what is the most cost effective way of treating us, and the NHS is expected to make constant savings. It can also be difficult to diagnose us. The suicide stories you hear always seem to include somebody saying “They seemed fine. They seemed to be getting better”. Maybe the suicides are our way of justifying all the trouble we’ve caused once we start to get better: “Look, we were genuinely ill. It wasn’t just attention seeking.”
And, of course, if asked, anorexic people tend to say they’re fine. We feel ashamed. Unlike famous mental ailments like schizophrenia or manic depression, anorexia is clearly something we’ve done to ourselves. It’s obviously a form of self-indulgence. You’re being silly and attention-seeking and perverse and making everyone miserable. You’re causing everyone a lot of trouble, and costing the NHS a lot of money that would be better spent on more deserving cases, so if somebody asks you how you’re coping you’re likely to say that you’re ok.
In fact, I even felt uncomfortable with how forth-right Mark and Maddy Austin were being about the underfunding and the lack of care. I wanted to say “No,no, don’t worry about us! We’ll be fine…”