‘Like any mental health issue, teachers must be very careful when intervening in eating disorders and self-harm’
The recent past has given us not only National Eating Disorders Awareness Week (last week of Feb), but also Self-Harm Awareness Day (1 March).
Eating disorders and self-harm make up two of the four commonest mental illnesses in under 21s (the other two being anxiety and depression). In the past three years, hospitalisations of young people in Britain presenting with eating disorders and self-harm have doubled. Our prime minister made specific mention of the government’s priority to cut eating disorder therapy waiting-list times in his speech announcing greater investment in mental health, thereby acknowledging the importance and urgency of the issue. Self-harm and eating disorders are also commonly interlinked (arguably eating disorders are a form of self-harm and symptoms of each often go hand-in-hand).
Having said all of this, effective ‘awareness raising’ when it comes to mental illnesses which involve a physical expression of distress is an incredibly precarious line to tread. Eating disorders and self-harm are notoriously competitive conditions – There is a perverse mentality which spurs those in the grips of these illnesses to be the ‘worst cases’ and therefore the most ‘impressively’ determined to abuse themselves, or even to have been the closest to death. Unmonitored online support forums contain hundreds of vulnerable young users' pictures displaying their self-mutilation, or comments proudly sharing their lowest weights as though they are badges of honour.
Indeed, a significant proportion of so-called "pro-ana" or "pro-self-harm" websites began their lives as groups designed to support those in recovery, quickly escalating into a place where people in emotional distress can share tips on all the most toxic and dangerous ways of expressing it.
My wonderful friend Kelsey Osgood, author of How to Disappear Completely (an eloquent expression of the challenges within the mental healthcare system in America, which I recommend to anyone who’ll listen) shares my concerns over awareness-raising initiatives. In her characteristically articulate way, she says:
“They handed teenagers pamphlets that listed alcoholic and anorexic behaviours, hand-outs with pictures of girls with their heads bent toward empty plates and posters with aphorisms blazing across a photograph of a scarred arm…These ‘awareness’ campaigns can alert the typical teenager to the many ways he or she has to express woe. In a byzantine way, the initiatives can inform the child what he or she should be doing: This is age-appropriate behaviour and guaranteed to attract attention from peers and, eventually, authority figures.”
Clearly, then, awareness-raising presents a danger not just to those presently struggling with the issues they seek to raise awareness of, but to Kelsey’s ‘typical’ teenager – a young person who is a little angst-ridden, trying to find their way in the world and express a sense of identity.
Despite official guidelines issued by charity B-eat as long ago as 2010 on damage-minimising ways to discuss eating disorders, the mainstream media have been reluctant to acknowledge the potential impact of discussing weights, measurements, calories and eating disordered behaviours. The celebrity weeklies, in particular, seem intent on printing endless pictures of emaciated women in their underwear, alongside 800 word ‘how-to’ guides in the ‘art’ of anorexia.
It was for this reason that I chose to share my own eating disorder story with one publication and one journalist only – the excellent Rosie Mullender of Cosmopolitan, who handled my case with all the sensitivity and care not to trigger the reader that I knew she would. Countless other publications approached me and immediately requested photographs of me "at my thinnest" or "when modelling" (fortunately, owing to my being ancient by model standards and having had a different name during my brief career in the fashion industry pre-social media, online pictures of me in my slenderest state are a) incredibly rare and b) almost impossible to find).
When I challenged publications and TV shows on their incessant demand for visual evidence of a condition that was a mental illness and therefore took place in the invisible recesses of my brain, they told me that the media was by its very nature a visual medium and that there was absolutely no way to circumnavigate the problem.
All of which is why I was beside myself with delight when, for Eating Disorders Awareness Week this year, the Guardian published a veritable masterpiece in how to discuss bulimia without being even remotely triggering. The article, by Caroline Jones (author of The Spaces In Between) not only manages to perfectly encapsulate the emotional aspects of bulimia nervosa, but is also more than 50pc about recovery. It is everything an awareness raising endeavour should be – equal parts illuminating to inspiring. Most importantly, it gives hope.
Similarly, this month charity Young Minds, in collaboration with the Charlie Waller Memorial Trust, have released three self-harm resources, one for young people, one for teaching professionals and one for parents, which manage magnificently to openly discuss the issue in a positive and non-triggering way. The videos, which were made in consultation with young people who have experienced self-harm, emphasise the importance of communication and of finding an alternative way to express difficult emotions. I cannot recommend them highly enough.
So, in conclusion: yes, it is imperative that we reduce the stigma and increase understanding of mental illness by having a frank discussion, but as the adults guiding young people, we also have a responsibility to do so in the right way. With any mental health intervention, there is always the risk of doing more harm than good. So bravo to Caroline Jones, Young Minds and the Charlie Waller Memorial Trust for showing us how it should be done.
Natasha Devon is the Department for Education’s mental health champion. She tweets at @natashadevonMBE