Openmind 124, November/December 2004
She thinks the boredom will kill her or that she'll go out of her mind worrying about her weight and the decision to come into hospital. There is no television, she isn't allowed phone calls and staff are too busy to talk to her. Confined to a side room in an anorexic ward, her puzzle books and letter writing offer limited distraction. The only human contact is with the nursing assistants who come to empty her commode or sit with her at meals.
It's hard to offer words of encouragement and comfort in response to my friend's letter. If I thought that re-feeding treatments in psychiatric hospitals or specialist eating disorders units (EDUs) could mend long-term anorexia and bulimia I'd be more optimistic.
Her letter resonates with my own past. I was once a skeleton in a bed. Then, I languished in hospital for six months at a time. There was no compulsion to remain on those wards, but did it amount to a choice? Discharging myself would have meant returning to problems at home while in the acute, all-consuming stages of anorexia. I grasped the treatment option with both hands. At that time I was a non-person, at a loss as to how to feed myself; forever deprived of nurturing and the right to exist.
I soon found out that being re-fed isn't a gentle coaxing to eat with constant support, some negotiation and flexibility. The reality, as for my friend, is oppressive and can be experienced as a violation. For starters, patients remain on bed rest until at a weight that puts them out of the severely underweight category. Then, as the weight piles on - EDUs expect a minimum of 1-1.5kg a week - there are more 'privileges'. Patients may be able to take a walk in the hospital grounds with a member of nursing staff. They will be allowed to eat in the dining room on the 'supervised table' instead of in their rooms. Those on the eating disorders programme will sit together, with one or two nurses watching them complete everything on their plates - down to eating skin from meat or fish. If there are any refusals, peer pressure will be invoked and the group will have to remain at the table until everyone has finished.
Where anorexia forces you to be preoccupied with food, the world of an EDU intensifies the obsession. The day revolves around food. My memory of mealtimes is of a table of anorexic women waiting with trepidation for the food to be served. There were the disputes over portion sizes - especially ice cream, potatoes and cream sauces - temperature of the food, who had been given more and its unfairness. We each had ways of mentally retaining some control - mine included sitting on the same chair, wiping my mouth repeatedly, eating food groups in a certain order. After every meal, patients had to sit together for an hour's 'supervision period', stopping them from vomiting.
Your every move is watched by staff ready to advocate psychotropic drugs to relieve 'problems'. I was given antipsychotics to control my cutting and told that my place on the unit was in jeopardy because of my behaviour. One-to-one observations were also used, which made me more determined to find ways of self-harming. I had to cut my arms with razors since this was the last vestige of control I had then. Seen as too withdrawn, I was given clomipramine to bring me out of myself.
The loss of freedom is sudden and then enduring. You are no longer an adult living in the world. Instead, you are treated as a naughty child who cannot be trusted and who doesn't know what she wants anyway. Maternalism is inherent in this and taken to extremes. One friend being treated in an EDU was told she couldn't sit on the same bed as another patient, since staff consider patients to be going through a second puberty during which they may become 'confused'.
'Progress' made in hospital isn't easily sustained once discharged. It's hard to get used to eating without being watched; to continue the rest of the journey for yourself; to stop equating every move and thought with food - the guilt that you haven't eaten enough and 'they'll' be on your back again. Alternative treatments, away from the medical model, would put those of us with eating distress back in control. Examples include aromatherapy, opportunities to talk to a therapist, nutritional counselling (informing us of the right foods to put in our bodies), massage and yoga. My other wishes are for holistic approaches, a stronger network of support among survivors, and long-term relationships with counsellors or nurses to provide continuing care - all means to improving a person's outlook and averting wilful self-destruction.