At the beginning of therapy sessions, we usually have a “Check In”. We each tell the group how we are currently feeling. We feel pressure not to be ok. How can we justify our place, here; how can we claim to be genuinely ill, if we stride into workshops full of the joys of spring? Better to creep weakly in, all twisted up.

In reality, sometimes we’re fine and sometimes we’re not. More often than not, we’re not. Every day is the same, here, though, so the difference must be in us. We’re inconsistent and unreliable and we must accept this.

Our recovery probably begins by acknowledging that the critical component in any situation is not the immutable external facts, but our interpretation and emotional response to it. People are driven, overwhelming, by their emotions rather than their reason, I think. Passion, rather than rational debate sways us; intense emotions, not clear arguments, are memorable. We are not homo-sapiens, we’re homo-affectus.

Therapy relies on the hope that rationality and language can still have some use in self-management. Apparently, we are governed by assumptions, values and beliefs so deeply embedded that we do not stop to question them. They trigger thoughts and emotions, which trigger actions so immediate, and so habitual, as to be essentially thoughtless. Jamie, one of the therapists, calls this instant, un-critical response “fusion thinking” because the beliefs, thoughts and resulting behaviours are all fused together in one unreflective lump.

The therapy team try to train us to step back and examine our mental procedures, and identify what’s going on in our minds. We can then persuade and convince our mad, impulsive sides by the brilliance of our own internal rhetoric, by our impeccable, logical arguments. That’s the hope and theory, anyway. They are very good at bringing the known into focus, defining and articulating it, but it’s difficult to remember even the most carefully explained coping strategy when you’re gripped by the scaly claws of anxiety. I guess it takes practice.

(let your mind go, let yourself be free/ oh freedom (freedom)…)

I’m still feeling jaded by the constant struggle of being here. Because you don’t want to be here, you’re forced to constantly confront why you ARE here; you have to question your motivations and drives, resist your negative impulses and thoughts, analyse your mental states, discuss your, and others’, behaviours and what causes them. You can NEVER relax and the process seems to have no fixed end: it could go on forever! Even our music and art classes involve intense concentration, using parts of the brain that have lain dormant for decades. But then, every aspect of anorexia involves struggle.

When I feel grim and snappish, I try to get away from people and do paced breathing, usually in the garden. This partially works, and I appear more relaxed, but it’s a superficial calmness. I can feel a deep and powerful current of anxiety flowing in a subterranean darkness.

I usually have no idea why. I try to “step back” and examine my own thinking, as I’ve been told to in our therapy sessions, but I’m utterly rubbish at it. When asked to analyse my feelings and thought processes, I’m flummoxed. Nothing comes to mind.

I think I lack the habit of true, internal dialogue, something I suspect is fostered by conversations with other people (and possibly by reading fiction). In my solitary anorexic past, a thought seemed like a statement of cognitive fact, an immediate description of interior reality. Wasn’t that the lesson of all post-Cartesian philosophy, that we can know nothing beyond our own thoughts? There seemed little point in observing the sensation of having thoughts; their content was the important thing. And, anyway, no alternative could be heard above the seething moil in my impoverished mind.

Now, at least I’m aware that I have thought processes, and that they can be wrong and based on unhelpful assumptions. I sense them, fluttering indistinctly, like crows in a tangled hedge, just beyond the streetlights.

I can even come up with plausible explanations, coherent narratives. They feel plucked from the air, but after a couple of days, I’ve bedded them in, and they seem self-evident, solidly rooted in undeniable facts. I Sometimes wonder if all therapy is simply the imposition of a pretty story, almost at random, on a stew of uncontrollable bio-chemicals. Connecting the pieces makes us feel better. We think we understand ourselves. We feel more in control, but it makes bugger all difference. The brain continues to do what the brain continues to do.

Recently, when I couldn’t find a quiet place to do the homework for one of our workshops, I was almost overwhelmed with frustration, so I tried one of the self-soothing techniques they taught us. I went outside and observed the rain falling, the tips of myriad leaves dripping, dull greens turning to dull browns, into the garden’s misty distances; the smell of frying; the sound of raindrops on my umbrella, traffic on the road.

Perhaps this did clear my mind a little, because I discovered the claustrophobia of being totally immersed in a completely controlled environment. (You’d think I’d’ve worked that out already!) I also worked out that I want to do the homework well, because I want to be useful. Then there’s the familiar feeling of mental inadequacy, along with a fear that the other patients will sense my frustration, and take offence, and I very much want them to like me. (which is a new feeling for me and probably a sign of a re-nourished brain!)

So at least I’ve worked out that I hate being grumpy. That’s a start. And, although I try to hide it, people can intuit these things. My sense of value, in Ascot House, comes from being a good and supportive member of the group, being useful to it: it’s servant, and the facilitator of palliative experiences, so if I am even mildly difficult and unsettle people in the slightest way, I’m no good to anyone.

Everyone in here is desperate to be helpful, to be supportive of others, to be good, to be liked. Sometimes, visitors mistake me for a member of staff, presumably because I’m a 47-year-old man, and thus don’t fit their mental image of an anorexic. Really, though, I’m that stock character, the lunatic who thinks he’s one of the warders. Or wants to be. Like everyone else.

I spent a lot of mornings, in my early days at Ascot House, lying awake, toying with the notion of simply evaporating (fading far away, dissolving and quite forgetting.) It’s an idle speculation that sometimes floats into my mind when things seem tedious or exhausting, as a way of bringing them to a close. It’s not clearly imagined; it’s simply a habit of reflection; a way of looking at the world.

I lack the drive and energy, perhaps the solipsism, to follow up on the conception. I’m just one of those people who thinks, “Bloody Hell, I’ve left my ID badge at home, again. I can’t be bothered: maybe I’ll just kill myself.” Anyone who imagines self-slaughter as the solution to their sheer bloody laziness is unlikely to act on the ideation. But don’t tell me I’m alone in it! Admit it, you do it too!

I think it is also a response to a feeling of helplessness, the sense that you are simply not up to the tasks of living; that you are not adequate. When I have these thoughts, I’m imagining giving up. I am getting down on my knees and bending forward until my forehead touches the cold soil, but without getting funny looks from passers-by, or wet knees and forehead.

My friend Cath has a condition which causes her to fall over. I forget its name. (With us, there’s always a justifying condition, always a name.) Sometimes she just clatters to the floor, but if she feels the faintness coming on, she lowers herself to the ground in preparation. Sometimes you stumble on her, literally, in the hallway, quietly stretched out, face down, with her head on her forearms. She is throwing yourself on the mercy of the world. It is a form of communication. It is an attitude of surrender.

But I don’t have such a condition. I am more restrained.

There’s a fury in her that I lack.

The days here seem particularly endless and full of tension and people. For some reason, the television and two separate radios have to be left on all the time, by management diktat, so you’re constantly assailed by feverish, contradictory gabbling. It doesn’t help, here where men sit and hear each other groan… where youth grows pale and spectre thin and dies; where but to think is to be full of sorrows…

Without the structure, the strict timetabling, and the SMART and urgent targets, of an eating disorder, your whole future existence seems much blander and more aimless, its pleasures watered down; its passions mild and aqueous. You slump, uncorseted, in your chair. It’s difficult to know what to be up to. Life isn’t pointless or joyless, but may be vulnerable to becoming so. You seem doomed to spend eternity wandering over a wide and featureless ocean like some pot-bellied and jaded Odysseus, or the Wandering Jew. Oed’ und leer das Meer. I guess I’ll just have to sit it out. Enduring is what we’re good at.

By the time anorexics, are deemed ill enough to be admitted to Ascot House, they have consumed the fat which insulates our organs, so they find it difficult to maintain their core body temperature. At first, we all creep around with hunched shoulders and crossed arms, huddled into jumpers and cardigans and complaining of the cold.

Everyone also complains, fretfully, about the sun shining in their eyes and asks for the blinds to be pulled down, submerging us in a sickly yellow gloom. I think we’re trying to hide ourselves away for shame. We’re strange, shivering troglodytes, half alive, half interred; half asleep, half hypersensitive: shambling, hot-house zombies.

As they feed us up, our bodies reconstitute their tissues, cosily lagging our interiors with layers of fat. Now Ascot House feels hot, head-achy and stifling to me. Mysteriously, somebody keeps turning the thermostat up to 25 degrees centigrade. You can’t escape it because the windows are firmly shut, and you’re not allowed to leave the building, or even go upstairs. I googled “optimum house temperature”, and most websites recommend around 18-21 degrees. (18-21 DEGREES, PEOPLE! DID YOU GET THAT?!) I think there must be cold little elves that creep into the house at night.

Anorexics are rejecting their own corporeal limitations. We are shaking our fists at our own pathetic bodies and their disgusting secretions and emissions. Gloriously, when you’re very thin, you don’t sweat. It’s amazing, just as my weakened sphincter constantly emitted the loudest rasping, stuttering farts, but they were completely dry, odourless and inoffensive.

Now I’m “nicely insulated” again, and I’ve become terrified of feeling hot. I fear the return of sweaty, greasy skin, the faint ripe, meaty, dungy whiff, rising up from under my shirt: sour, yeasty, fungal, curdy. Sometimes, when I take my clothes off, for a horrifying moment, I detect a smell like a newly opened tin of spam. Is it me? Can everyone else smell it?

Meals and snacks are the most challenging parts of our day. There’s incessant questioning and over-thinking. When you eat, you are surrendering, luxuriously, to your hunger. This is a terrible failure. After all, you’ve spent years resisting hunger, but now it is your duty to yourself and to everyone that you deduce you love, and who claims (incredibly) to love you, to force yourself to give in to your appetites: force yourself to give in – in that phrase is all the self-contradictory, stereophonic double-think of this condition, the yabbering of many voices. With an internal dialogue like this, it’s no wonder we seem dazed.

Eating is expected (why else are you here?), so it’s not your fault if you do, but what if you enjoy it? Oh, the terrible deliciousness of it: vegetable curry, chicken kebabs, sweet potato tagine! We eat turned away from each other, our hands up to our faces to hide our struggling, ecstatic, horrified expressions. Each meal ends with someone, having grimly done their duty, crawling, sobbing, from the table. You find them curled up on the sofa with their eyes closed, seeking unconsciousness, the relief of mental shutdown.
Half asleep with a loaded gun
In a room with a light-bulb sun

The therapy and workshops also keep drawing your attention back to the purpose of being here, the seriousness of the condition you’ve invited on yourself, the embarrassment and shame of it; the difficulty and yet absolute necessity of constant vigilance, of constantly challenging all its symptoms, its behaviours and tics. You’re supposed to scrutinise and challenge every suspect thought and assumption, and the constant supervision, and the rules, interrupt your relaxing, restricting compulsions. You are unable to bed yourself in to comfortable routines that allow you to abandon judgement and analysis in favour of their soothing rhythms.

Because we share rooms, we are never alone to recuperate from all of this, to brood, from the moment we wake to the moment we escape into sleep, our only solitude. I find socialising very hard work at the best of times. I feel the strain in even the simplest exchange and I’m always desperate to get out of them. I’m also hyper-aware of, and sensitive to, the imagined scrutiny of my housemates, whose good-will I rely on. It’s exhausting.

Every morning I fight my way out of a panicked sleep, too early and very alert, grateful to be awake. I’m driven to rise by a sort of anguish, yet actually getting out of bed, swinging my legs over the side, is daunting: everything that follows is too significant, too fraught, too dangerous, and, by evening, when I go back to bed, I realise I’ve been feeling catastrophically anxious for hours, by which I mean I’ve been anticipating some undefined catastrophe.

And all this takes place against an unchanging, apparently endless progression of days. Days pass, weekends tick over. It feels overwhelming, when you remember how life continues at home and at work, progressing, diverging from you. You know you’ll return as a stranger.

On Sunday evenings, everybody feels glum. Another week, struggling with terrifying nothings, looms ahead of us: boredom, bewilderment and unfocussed, formless distress.

This may explain the agitation.

Don’t think we sit in the garden all day, in wicker bath chairs, under tartan blankets, whining. There is a fair amount of whining, but just being here is a struggle, from the moment you wake until the moment you go to sleep.

We’re not ungrateful. Everyone here has reached a crisis point (although we would probably deny this), but so have thousands of other people in Britain. Beat, the eating disorders charity, reckons there are 1.25 million people in Britain with an eating disorder. Ascot House, with proven record of success, and a warm and supportive atmosphere, has only 10 beds. We are incredibly lucky to be here, paid for by the creaking, foundering NHS, and we know it.

This puts us under enormous pressure not to squander the opportunity, to embrace it, to make the most of… rise to …challenge… get to grips… grapple… struggle… urgent…necessary… constantly. Constantly.

We know this. We do try. We do. But we don’t feel it, and we don’t want it. We do it out of a sense of duty.

Finding yourself abandoned in this foreign place, among strange faces, makes you constantly aware of the seriousness of your condition, and of the necessity of the struggle: every morning when you wake, a guest in an unfamiliar bedroom, and you ask yourself, “what am I doing here?”, you must answer, “because I have an eating disorder that is trying to kill me”. When you ask yourself, “How the hell can I get out of here?”, the answer comes back, “by defeating it”, because the alternative, discharging yourself, creeping back into its scabrous, sinewy, outstretched arms, is even less inviting, more exhausting. For me, at least. Jo has given me an ultimatum, after all.

Not for all of us, though. Some of my comrades resist and resist recovery, especially at mealtimes. They sit, hunched and miserable over bowls of soup, stirring and stirring them until they are unpalatably cold. They rush from the table: plates of abandoned food sit sadly steaming in front of empty chairs. Cath, one of my particular friends, turns to me and the creature is occupying her features. It speaks with her voice and says, “they can’t seriously expect me to eat this, can they?” And I smile with non-committal sympathy and squeeze her hand and think, “I recognise you, hypocrite lecteur! – mon semblable, -mon frere!”

“Poorly writers with time on their hands are, I suspect, rather a bore…they plead their case; they become their own subject” (Sarah Perry, in the Guardian Review, 29th September, 2018)
(“Writer”, here, meaning somebody who writes, not someone who’s published)

My pre-dawn moods have settled down to a sense of morose fretfulness. I suppose it’s an improvement, although they still occur every damn morning. Sometimes I fret about overshooting my target weight; not deserving to be here; splitting up with Jo; having no structure or aims to my life; fitting back into my family and home. Most of the time, though, I’m just mardy. Something in my subconscious, released by sleep, spends the night fermenting frustration and gloom. I suppose it could be caffeine withdrawal. The moods evaporate suspiciously quickly when I get up and have coffee.

More evidence for the stimulant theory can be found in my general agitation. It often occurs sometime after the caffeine hit. On the other hand, maybe I’m just more aware of a natural, underlying nervousness. We are prone to navel-gazing over-sensitivity, in here. It’s a side-effect of the therapeutic process. We are taught to be aware of, and to analyse, our own internal states, which are no longer drowned out by the concerns of work and day-to-day life. My diary is full of entries that read, “It’s 6pm. I’ve been strangely agitated today. More so than usual, I think. I’m not sure why.” It can be a persistent and intense feeling, but I’m unable to make explicit links between my mood and my circumstances. I’m emotionally inarticulate, which makes it difficult to implement one of the mindful, CBT strategies we learn in our workshops. I try to stand back and identify my feelings, values and habits of thought, but I can’t establish an internal dialogue. Anything I say to myself seems like a bald statement of fact, a dull thud resounding in my head, its muzzy echoes unanswered, unanswerable. Do other people find this?

Nourishment seemed to be accompanied by strange spikes and firestorms of undirected emotion. My re-activated synapses were flexing and stretching as they came back to life. When I was first here, I often woke to confused emotions raging in my breast. It wasn’t the normal Matutolypea we all experience; My brain seemed to be venting excess feeling. I’d lie in bed flaring baseless anguish and despair. It would leave me shaking and agitated.

Then I went through a stage of getting strange little stabs of emotion during the day. They seemed like bursts of gleeful energy, compelling me to do something to break free of Ascot House. Worryingly, they manifested themselves, largely, as a desire to happily end myself: not kill myself, just somehow log off…

According to the therapy team, when you are denying yourself food, your brain reduces the amount of neuro-transmitters it produces. These are the chemicals released by a synapse when an electrical impulse travels along a nerve. They are picked up by the next synapse, which triggers the next electrical impulse. Without enough food, the brain offers a reduced, skeleton service of essential functions, so your emotional systems are starved off and dampened down. This is why you become so lacking in empathy or mental flexibility.

There is a theory that the starving brain becomes particularly sensitive to the release of what few neuro-transmitters are available, to eke it out the reward delivered by serotonin, the chemical that’s also associated with happiness or satisfaction. You become more reactive to the data you are still able to process through the neural pathways you’re still using: you become a sensitive little sod, in other words.

We overthink everything, and see too many implications from the smallest phenomena. We startle and take offense easily. Because our brains lack sophisticated metaphysical functions, these thoughts and feelings lack depth, profundity or impact. We exhibit a blend of quiet, sanguine misery and self-blame, along with a determined resilience. We nurse and remember our wounds but without self-pity, because we are incapable of pity. We suspect we are disliked and despised, but our paranoia doesn’t bother us much.

As you recover, though, you are once again flooded with neuro-transmitting compounds and your emotional systems begin to function once more. You are no longer numb, but are just as sensitive and much more volatile. Your hyper-sensitive, re-nourished synapses fire random emotions across your brain. As Jamie, one of our therapists, put it, “you’re hit by a tidal wave of emotion”. It’s like being a teenager all over again.

We are rude, intolerant and unsympathetic yet, simultaneously, we are immensely over-sensitive and vulnerable. Imagine living in a house with 9 other such emotional monsters, unable to leave the building, having to share a room with one of them!It is greatly to our credit that the situation doesn’t descend into a dreadful, murderous bloodbath.

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.

For at least a couple of years, I’ve been driven, and tried to be driven, by urgent needs from the moment I wake: the need to run and get it finished; the subsequent, desperate need for my breakfast; the need to get people up for work and school; the feeling that if I don’t urge myself forward I will collapse, through laziness or exhaustion; the need to be busy to prove I’m a useful individual.

I’m released from this, now. My typical day starts with an enforced lie in. When I first arrived in Ascot House, the days were longer. I could peer at my book, trying not to wake my room-mate, as the light slowly strengthened and time achingly crept by. It’s darker, these days, so I can’t even do that. I ought to lie in bed reflecting on things, but there seems nothing to be said or thought. Miasmas of emotion, vague and ill-defined, eddy and moil through the echoing chambers in my head.

This idleness doesn’t seem unwholesome, yet the looseness and freedom, the apparent emotional neutrality, give me a (tranquil) sense of the profound slightness, or the profound hollowness, of the self. It seems to me that we are a loose and serendipitous association of sensory data and a few mild impulses: a cold nose and a slight headache, allied to apprehension about the future, say; sore feet, and a distaste for drains, attached to a dislike of conflict. We have no core, or essential being, no soul. Most of our DNA is junk, after all, and our useful traits appear to have developed by accident.

At 5.30, I creep into the bathroom, where I can read, while avoiding looking in the mirror. There’s a large, sash window and, on a fine, clear morning, a modest blush of pastel shades is lent to the misted panes. It’s a nice contrast to the variegated bathroom whites – gloss window frame, whitewashed walls, old, enamel bath. If the window is open a little, you can see the tops of the hedge and the few remaining trellised roses next door; often a single bird is singing in a spare, abandoned, autumn dawn. There seems to be far more depth and meaning to these perceptions, now that I’m better nourished. When you’re ill, you live in a world of un-affecting facts. Sunrise is simply sunrise – nothing more.

Leaving the room at 6.30, it’s like Piccadilly Circus out on the landing (these bloody insomniac anorexics!) It’s especially bad on Mondays and Thursdays, which are the days we get weighed, with our backs to the display so we can’t see how much we’ve gained. Those of us with abnormal blood-pressure, usually the thinnest among us, also have it checked by the poor, red-eyed night nurse.

Luckily, when I get downstairs, I’m largely left alone until 8.30, to luxuriate in BBC Radio 4, the papers from the weekend before, and my coffee.