An Extra Treat

Having never been incarcerated as an inpatient, I cannot provide a first-hand account of this regimented way of treatment. A brave sufferer offered their own witness account of their time at a private (the NHS do subsidise if need be)  adolescent Eating Disorder clinic based in London, who accepts both gender patients aged 8-18 years of age. She was made an inpatient at the tender age of 8 after being diagnosed with Anorexia Nervosa due to a need for control. She went on to make a successful recovery only briefly relapsing in early 2010, but was immediately taken on board for renewed treatment proudly reaching the state of ‘in remission’ in the summer of 2011. Of her plight with Anorexia she recounts:

‘It started out that I was so worried and nervous that I felt physically sick and then after a while not eating became the natural thing to do. That was when I noticed the bones and it developed into a weight loss thing, especially once I'd entered the clinic with all the other girls. There were two kitchens, a blue and a brown. When you first got there you ate in the blue where you were under a lot of observation and once you progressed and could be trusted you were moved to the brown kitchen. Everyone had privileges, like phone calls, visits, days out of the clinic with family, etc. If you didn’t make your weight target for the week, lost any weight or were found doing any of the illegal activities (exercising unsupervised, throwing up, hiding food in your clothes/room etc.) you had privileges taken away. Because I was one of the younger girls I rarely had phone or visiting privileges taken away but I did have my exercise cut. I suppose some people might think it’s crazy to allow anorexics to exercise but it was very controlled and it was all about trying to integrate back into a ‘normal’ life with normal, healthy habits. At first it was like being force fed, because there were so many rules attached to meal times (you couldn't fidget, you had to eat at a certain rate and were told how big a forkful you needed to be taking etc.), but you couldn’t really get around it because the staff were so used to it. Everyone had the same basic meal plan so there weren't any disputes as to who was having what, it also helped that everyone was sort of in it together in a sense if we were all having to eat the same thing. Everything was also measured out so you really did have the same. We all had to eat together in whichever kitchen and with supervisors in the blue kitchen too. Plate clearing was a definite - you had to be able to scrape your plate clean, they were even strict about crumbs because it’s all about breaking the cycle of thinking that even 3 less crumbs = less calories.

You had group, individual and family therapy a couple of times a week and specific slots to do school work too. I personally found group therapy the most useful while I was there, once I got to know the other girls that is. It was hard to see the girls that came to be your friends in a weakened state, especially because you knew exactly what they were going through, but it did become a bit of a family atmosphere once you settled in.  Family therapy always was and is the hardest part of recovery for me. I always felt as if I couldn’t really express what I was feeling to my parents because I always wanted them to think I was getting better, even when I was at my worst and obviously just spiralling downwards. The sorts of things they made me do in individual therapy, other than the general talking part was to draw pictures, point out my feelings on a scale, identify who I thought was most like me out of a picture of people, etc. Odd stuff I guess, but I guess that’s what they had to do for an 8 year old. The emphasis was on both weight restoration and challenging your behaviour around food. Even if you were reaching your weight targets for the week if the staff still hadn't gotten to the cause of why it happened, they often assumed you were one of the many who were just eating to get out of the unit so you could potentially continue losing weight outside.

However the other side of inpatient is that it is very easy to learn from the other patients. When I was first admitted all I knew about Anorexia was what I had been told by the doctor who diagnosed me - we hadn’t learnt about it in school, there wasn’t anything on the internet as far as I knew, I’d never come across it before but all the things that described an anorexic described me at the time. Once I entered the unit I learnt so many tips and tricks from the other girls, how to hide food, how to make myself throw up, how to make it seem like I’d gained weight for weigh-in, and what calories were. In this way it’s not the best environment for recovery because everyone is kind of encouraged by everyone else to keep going with your behaviour as much as you are there to recover. At first, when I was in this new environment where it seemed they were stuffing food down my throat constantly throughout the day, learning these new tricks helped me to keep some form of control and resist the changes they were trying to make in my life and habits. For this reason I did actually get worse before I got better in inpatient. For other girls they went the opposite way and quickly reverted back to normal eating habits simply so they could get out sooner. However the staff are pretty savvy to all of this, they’ve seen enough over the years that they aren’t easily fooled like our families could be.

Overall I can’t really fault it, their expertise on what was happening to me and my family helped us all in a way that I don’t think would’ve happened if I hadn’t been admitted. And while I have previously relapsed, I’ve recovered again with their support.’

Another equally thought-provoking testimony was delivered by a girl who developed Anorexia in her late teens though she- like me- was never made an inpatient. Her own account bares many resemblances to mine, as I can relate to a lot she admits to. She was the first one to offer me her own story when I was diagnosed, as other sufferers I knew found it too hard to talk openly about. She was further in her recovery than me so she provided a support when I attempted my first challenges, assuring me it would get easier. So far she has not been wrong…

‘My mum knew I had a problem- I kept hiding and being deceitful. Then I knew I had a problem and hated the control it had over me, so I admitted it and we went to the doctors, they straight away diagnosed me to Cams, an eating disorder clinic, but this took a while. In the meantime because my school was aware they took me to speak to someone, she wasn't a specialist she was more for therapy and thoughts. If anything, it gave me so much control because my mum and school knew I wanted to get better so I would make a point of saying ‘no I have to do this’ so they let me get on  with it, as they were just happy I was doing something about it. But I was losing more and more weight; this is was when I was at my worst. I was fighting the most yet had the least control even though I was getting better.

I finally went to Cams with my mum and they basically told me I was going to die. This woman would be my therapist, I hated her from then on because I didn’t like what she was saying and I felt like she didn’t understand. I look back now to see she was talking so much sense and my hate was because I was uncomfortable with the reality and what I was actually going to need to do to get better. They decided I would even need to be an inpatient or have a nurse that would visit me regularly. I refused to go in as this was something I wanted to beat myself and I wanted to prove to everyone that I could.

A couple of months later and a few appointments had gone by with the woman I HATED (it was so weird, I was so rude to her, it was so unlike me) when I finally starting seeing my nurse, Tina. I was so excited, as I really thought this was going to be it; she was going to give me meal plans. The thought of that excited me, as it was like I was being given permission to eat which is what I wanted to do for so long but it was something that I just couldn’t bring myself to do. I really got on with Tina my nurse meeting twice a week where she would weigh me and we would set up meals for the next couple of days. I remember the first time she came over, my calorie intake would go up gradually by 100 until eventually reaching 2500. I couldn’t believe it and was so scared yet so excited to eat! I remember one time when she left, we had arranged that I would have a jacket potato for dinner, I was so excited to have coleslaw on it, as this was one of the foods I missed most but I decided I would dare to try it. Tina really helped, in a way made me see sense and would have an answer for everything; she was a real help in my recovery. These meal plans became OBSESSIVE; we would spend hours and hours just doing two or three days, as I needed them to be perfect and when she would leave, I would carry on.

My exercise increased and she demanded that I stopped going to the gym, this was a massive step, but I did it and haven't been back since- I just walked about. After a couple of weeks, my weight went up then it just stopped and I was no longer putting on anything, just loosing yet I was eating! There was a bed waiting for me at the inpatient at Rhodes Farm (an Adolescent Eating Disorder Clinic) and I was so scared, as it would ruin so much, school, exams everything. This was my motivation. I knew I could prove them wrong.

 I saw Tina up until I was 18 when I had put on a fair bit of weight; I was still underweight when I got transferred to an over 18s specialist. I hated this, as I was so fed up of going to appointments, I thought that because I was eating, I looked fine and I was fine so why couldn't everyone leave me alone? I look back now and realise I was still so obsessed with calories, I was cutting back food and I would try to walk everywhere I could however much people stopped me. It was the biggest emotional journey ever! I also attended a family course for a week with my mum and dad and a couple of different families, this was hard as my dad realised how serious it was. I learnt a lot about myself that I didn’t realise was a problem, I would spend hours in food shops being obsessed by all the food in there, taking a ridiculously long time to make a decision on what to buy then sort my purchases in the cupboards so they were perfect. I was trying to convince everyone I was better, yet I was still doing this and I was underweight. Because I was eating, I thought I was okay and wished everyone would leave me alone but people were still telling me I had a problem and I didn't like to hear the truth. I remember during this week that I kept thinking I was FINE, as all the other girls seemed to be so much worse than me.  I was proud that I was further than they were (two of the other girs were inpatients), as they took ages to eat their food, whereas I was fine and enjoyed what I was eating. It was then when my mum said ‘if you don’t calorie count any more, eat one of my dinners’ and I was replied with ‘fine. I will, I don’t have a problem with that’. To me this was a big step but to her I just wanted to prove so much that I could and would be able to laugh about that. So from then on I ate her dinners. It was a step at a time and you have to get over each hurdle gradually if you rush it doesn't work. I think my biggest problem was thinking I was better to quickly, so it was more of an emotional battle. At the beginning I went through stages where I would over indulge. This was difficult but I fought so hard not to purge as I hated HATED doing this.’