Our day properly begins at 8.30 with our supervised breakfast. The programme works by removing all responsibility from our shoulders, and only giving it back to us in small measured doses, as we prove ourselves capable of dealing with it. At first, we have to sit with a member of staff who checks we finish all our food. The rules at the table are frighteningly strict because we are such a mendacious and untrustworthy bunch and will resort to any amount of lying and cheating to squirm off eating’s (meat) hook. We are not allowed to wear hats in the house because patients use them to smuggle food out of the dining room, to dispose of later. One of the other residents once saw a girl put a whole omelette in her sock.
There’s a house meeting at 9.00 for announcements, and then the workshops begin. We have two or three group therapy workshops a day. These are called things like Body Image, Self-Esteem, Living with Emotions, Assertiveness, and so on. While each has a different focus, all these workshops share an attitude and an approach to anorexia which means they begin to blur into each other. They all encourage us to identify our thought-processes and mental habits, and the assumptions and values they are founded on. The aim is to bring those underlying and often flawed assumptions into the cold light of conscious scrutiny, then attempt to find ways to disrupt or redirect the unhelpful cycles of thought and behaviour they have engendered.
In addition, we have a weekly individual therapy session, a whole team review of our progress and care plans, and a programme of occupational therapy (O.T.) activities. This last includes planning and preparing meals for ourselves, under supervision, and even going out for snacks on our own as we become more confident in our ability not to cheat. (We have every reason not to trust ourselves). Finally, we have occasional talks by the nutritionist on the science of food.
I’m impressed by the programme, here. The workshops and 1-1 therapy, by their similar approach, reinforce each other, and feed into the more practical O.T. activities, which build your confidence and belief in yourself, and your ability. Down at the bottom of that deep well of my subconscious, dark shapes seem to be shifting and moving. It’s difficult to make out what’s happening down there, but perhaps great, foundational blocks of thought are beginning to re-align themselves. It’s disconcerting because I don’t seem to be doing anything consciously or intentionally. It’s impossible to properly monitor the changes in my thinking or my core beliefs. I can’t even be sure if they are going in the right direction. Nicola, the Occupational Therapist, tells me that repeatedly performing an activity, even if you are coerced into it, creates new neural pathways in the brain, and embeds them, so they become easier to perform even when you have the freedom to give them up. This probably seems self-evident, but is encouraging for us to remember.
We also have 3 meals and 3 snacks, all compulsory and supervised. They seem to come around remarkably frequently. When you first arrive, you are watched for up to an hour after each one. You aren’t even allowed to lock the toilet door, in case you try to puke, or dump any food you’ve managed to smuggle out of the dining room.
I have been identified as an exerciser, so I wasn’t allowed to take any exercise or even stand up, much, because anorexics will mine the smallest movement for any calorie expenditure, the smallest grain of comfort, and then we’ll try to repeat that action obsessively to gain greater comfort. We’re not allowed to go upstairs to the bedrooms or we’ll be nipping up and down the stairs a hundred times an hour, trilling, breezily, “oh I just forgot to get my book…”
When I arrived, here I had a Fitbit. These are also prohibited because they encourage you to exercise and check how many calories you’ve used. I, however, used to register around 17 kilometres and up to 4000 calories, daily, so there was no comfort to be found in checking an expenditure of a few dozen calories. I was required to spend the whole day sitting on a variety of armchairs and sofas. I sank into their soft cushions, forced to adopt a defeated slouch, which made my back ache.