Sky News presenter Mark Austin made headlines this week, after devoting a chapter of his recently published autobiography to the struggles he and his family faced as a result of his daughter Maddy’s anorexia.
Austin reflects on his lack of understanding of the nature of the illness, telling her at one point to "just get on with it" and during another argument "if you want to starve yourself, just do". Like so many parents, he could not fathom why his child should have to endure what he at the time believed to be self-inflicted suffering. Six years later, he is now angry at the lack of support he and his family had access to and has given a number of media interviews about his experiences.
One of these was on LBC on Sunday morning. Speaking to Andrew Castle, Austin expressed his frustration that the front page of The Observer reported the government once again calling for "urgent action" on social media to address the growing mental ill health in young people while not investing properly in services. “They had better believe they are storing up more crises in the future,” he said.
What struck me during the ensuing hour of talk radio was how many myths still surround eating disorders, despite their relative prevalence in the public sphere when compared with other mental illnesses. It is not so much that eating disorders don’t get enough airtime, but that media tends to focus on all the wrong aspects of the illnesses, thus perpetuating unhelpful stereotypes.
Perhaps most unhelpfully, the tendency is still to dwell on weight when assessing the severity of eating disorders. In just the same way as if a young person is self-harming the aim of their parents or teachers should not be merely to stop the self-harm, which is a coping mechanism, but to address the underlying reasons. So to focus on weight is to side-step eating disorders.
One caller to Castle’s show revealed her lowest weight but went on to emphasise that, while she might look "healthy" now, anorexia still affected her to the extent that an off-hand comment could be enough to affect her food intake for the day. Castle replied "think of how far you’ve come", referencing her past BMI. This was kindly meant, but missed the point by a spectacular margin.
Weight is the symptom, not the illness
Eating disorders are a mental illness, beginning and ending in the mind. While it could reasonably be argued that most of the population have a difficult relationship with their bodies and engage in some sort of disordered eating, this is not the same as an eating disorder. Anorexia is characterised by strict controlling behaviours around food and accompanying obsessive thoughts. Any changes to the body that result from these thoughts and behaviours are a symptom of the illness, but they shouldn’t be considered the focal point.
This was one of the reasons I founded the Mental Health Media Charter, which includes guidelines on eating disorder reporting. The charter draws on research collated by charity Beat, which shows that use of "before and after" photos and detailing specific weights and calorie intake not only misinform those not affected directly by the illness but can have a "triggering" effect on vulnerable people. This should be borne in mind when ordering school library books. If you type "anorexia memoir" into Google, the first book that appears is Marya Hornbacher’s Wasted, which has been condemned as a how-to instruction manual, carried around "like a Bible" by many inpatients because it gives so many "tips" on how to conceal and prolong their illness.
I am, of course, far from the only campaigner to be challenging these attitudes. As I type, the magnificent Hope Virgo is cycling from John o'Groats to Land's End to raise for the Shaw Mind Foundation and she also raises awareness through her #DumpTheScales campaign. Shockingly, even in 2018, if a person goes to their doctor with a suspected eating disorder, in most instances the first step will be to weigh them. There are all kinds of reasons why a person might not fit the BMI criteria to be considered worthy of expedient care under the current system (which renders the government’s promise to ensure no more than a four-week waiting list for young people with "severe" eating disorders by 2022 even more vague and unhelpful). Hope, myself and many others are striving for a world in which doctors measure psychological distress, rather than stones, pounds and ounces.
Natasha Devon MBE is the former government mental health champion. She is a writer and campaigner, and typically visits three schools per week across the UK. She tweets @_natashadevon