Health: Anorexia piles on the pressure

21st August 2009 at 01:00
Highly motivated A* teenagers who drive themselves to succeed might sound like dream students, but for anorexics the quest for academic achievement may be simply another manifestation of their illness

Original magazine headline: Piling on the pressure

Adi Bloom visited Rhodes Farm, a re-feeding clinic, therapeutic centre and boarding school in one

Three girls and a boy sit at the kitchen table, plates of mid-morning snacks in front of them. The blonde girl with the messy ponytail crosses her legs under her on the chair; her feet are hidden in enormous fake-fur slippers. "How many are you on?" the boy opposite her asks, brushing his hair out of his eyes. "Three thousand," the girl says. Neither of them needs to qualify what they are talking about.

The girl finishes her cupcake. She traces her finger across the plate, picking up each crumb individually. "I've got three kilos to go, but everyone's catching up with me. I totally thought I was going to lose my weekends."

The pupil-patients at Rhodes Farm anorexia clinic are not obviously emaciated. They do not have the gaunt cheeks or hollow eye-sockets of newspaper horror stories. But then the blonde girl leans her elbows on the table and kneels forwards on the chair. Her cardigan hangs off one shoulder and, underneath, her T-shirt lies loosely over baggy tracksuit bottoms. It is only then that it becomes apparent quite how slight she really is, how small under the oversized clothes.

Anorexics are generally practised at disguising the extremity of their weight loss. An oversized T-shirt or cardigan can hide ever-more prominent bones; a well-positioned hemline emphasises diminishing curves. Drink enough water before stepping on the scales, and they will conveniently lie for you. Drink Diet Coke instead, and the bubbles dull the appetite.

These are the tricks that Rhodes Farm was created to combat. Founded in 1991, the gabled, ivy-covered house in a north London suburb is boarding school, re-feeding clinic and therapeutic centre in one. Anorexic pupils are referred by their doctors, and stay for a minimum of 12 weeks.

Up to 32 girls - and the occasional boy - sleep in double and triple rooms, the brightly coloured homeliness attempting to compensate for the fact that their inhabitants are there against their will. The bedrooms are out-of-bounds during daytime, because their inmates might covertly exercise, or vomit up dinner. Instead, pupils bend over textbooks in a single schoolroom on the ground floor. Others gather around computer screens, as watery sunlight filters through the ivy.

"Not eating is the ultimate control. People can make you do most things, but they can't make you eat," says Tony Andrews, the former special needs headteacher who now runs the Rhodes Farm school.

"When patients first come here, they're not thinking straight at all. So it's not just running a school: it's part of the process of making them whole. Health is the important thing. Education comes second."

Anorexia a matter of control and desire for approval

Anorexia is an illness of control, not food. A desperate desire for approval - to prove to the world that you are not the big mess of wrongheaded neediness you believe yourself to be - is obsessively focused on what you do and do not eat. Hunger becomes a metaphor for emotional need. And needs are wrong, and must be suppressed. Dieting is merely a convenient lexicon, handily available to all teenage girls: diet and you win approval for your self-restraint, your control. And control, above all else, is what is important.

In the corner of the schoolroom, a girl in a bright pink jumper looks up. "The thing I hate is that people think it's all about being skinny," she says. "Yeah, I care about that. But it's not just that. It's wanting to feel like I can succeed at something. I wanted to show I had inner strength. I'm the kind of person that, if I start doing something, I have to be the best at it, have to succeed. When I started dieting, I had to be the best at it."

Katie Simpson was first hospitalised for anorexia when she was 13. Now 16, she has just taken her GCSEs at Rhodes Farm. "Quite a lot of people here have a tendency to be perfectionist," she says. "They push themselves really, really hard when it comes to schoolwork. There are a few of us who would revise and revise and revise until we knew it all. But I knew that, because I'd been ill, I wasn't going to do as well as I could have done. And that made me feel like a failure."

She fiddles with the beaded elastic bracelet around her wrist. Then she takes it off and loops it around her fingers, repeatedly twining, untwining, intertwining her hands. "Your memory's affected quite a lot, and your concentration. You're just so unbelievably tired all the time.

"But I'd made myself a promise that I wouldn't eat. When I first came here, I felt like a failure. I was letting myself down."

Mr Andrews liaises with the girls' schools, ensuring that they provide up- to-date work. There are in-house English and maths tutors, but he can also bring in specialist tutors to help with other subjects. The aim is that healthy pupils should be able to return to their schools with minimum disruption.

"Most of them are high-flyers," he says. "They're usually very intelligent, very bright, high-achievers. And sometimes that's their downfall. If they can't get an A*, then it's not worth doing. There's no such thing as average."

All or nothing

This all-or-nothing rationale is the cornerstone of anorexic thinking. There is no grey in the anorexics' world. Most fear that, once they start eating, they will never be able to stop: it is a choice between binge or starve.

At the long school table, Immy Turler shifts nervously in her seat. "In the morning, I used to say what I'd eat in the day, and stick to it," she says. "Say I ate a grape extra, I'd be really annoyed at myself. Not eating is like working hard at school, putting all your effort in, being a perfectionist and stuff."

Immy, 16, is three months into a five-and-a-half-month stay. She is tall, her hair unbrushed and unevenly parted. As she talks, she wriggles uneasily in her seat, her gaze drifting into the middle distance.

Previously, she was eating about 400 calories a day, a fifth of the recommended daily allowance. She weighed six stone when she was hospitalised and force-fed through a gastro-nasal tube. "I saw my admission photo the other day and it was" - she pulls a face - "eugh. Really not nice. I looked like a zombie. And probably felt like one. You lose all your emotions. You don't have enough energy to smile."

But she is not quite ready to let go. She has just returned from a weekend visit home, during which she played tennis and went swimming. Then she went for a four-mile walk across north London. "I've been put on a sitting programme for that. You have to sit for seven and a half hours a day. It's like getting your hair cut for hours and hours and hours." She points at a jumper, lying on a nearby chair. "If I wanted to get that jumper, I'd have to get someone to pick it up for me.

"A lot of people jiggle when they're sitting, or swing their legs to try to burn calories. But it's kind of a relief. You don't have to think, `should I sit or should I stand?' I'm going to have to just sit down at some point in my life."

The rules at Rhodes Farm are as unforgiving as the illness they are there to cure. On admission, anorexics are weighed, measured and presented with a target weight. They are then given a carefully calorie-controlled diet, to ensure that they put on exactly one kilogram a week until they reach this target.

New arrivals are monitored 24 hours a day, and must leave the bathroom door open at all times. Refuse to eat, and you are given a calorie-laden milkshake instead. Refuse the milkshake, and you will be placed on a gastro-nasal tube. Longer-term residents are allowed weekend visits home, but these can be summarily cancelled if their weight gain stalls at any time.

"They know from the day of admission that weight gain is not negotiable," says Tina Fisher, head nurse and unit manager. "So they don't have to feel guilty about that. You take all the responsibility away from them. Although there's lack of control, there's also lack of guilt. They're not choosing to do this."

Immy nods silently. "Right now, I just feel numb to food," she says. "I eat to live. But in a way it's a kind of relief. I don't have to make any decisions about what I eat or don't eat. Should I eat this or should I eat that? It's just so hard. The only thing I ever thought about was food."

Meals under supervision

Meals at Rhodes Farm are served in two kitchens. The brown kitchen is silent, tense: here, the majority of residents eat under staff supervision. Nurses watch for anyone attempting to hide food under their clothes; ritualistic eating is similarly banned.

In the blue kitchen next door, Michael Jackson plays on the radio. A basket of clean washing rests on one counter top, a fish tank on another. Pinned to the toaster, a fridge magnet reads: "There's nothing wrong with me that a little chocolate won't fix."

Pupils who are further along in their treatment are allowed to bring meals in here to eat unsupervised. Though, as Ms Fisher points out, "those kids supervise each other better than anyone else can".

Katie jumps up from her seat in the schoolroom. "I'm going to have to go for snacks now, unfortunately," she says. "Snacks = terrifying and traumatic. But what happens in Rhodes Farm stays in Rhodes Farm, is how I see it," she adds, as she sprints out of the room.

The blonde girl with the enormous slippers returns to the blue kitchen. Again, she leans over the table; again, she picks the cupcake crumbs off her plate with one finger. It is the gesture of someone who believes in all or nothing, who has given herself permission to eat this time, but knows it may not last.

Her name is Florence Cullen-Davies, and she is 15. She weighed 5st 11lb when she was admitted, two and a half months ago; she was previously in hospital for five weeks.

"It's difficult to watch the weight come on," Florence says, and her words are slow and measured. "You feel very, very trapped. You try not to think about what you're eating, to block it out."

She shifts around in her seat, and once again it becomes apparent quite how slight she is. "But when I look at myself in the mirror and see the weight, it's horrible. At the beginning, I just felt like a heffalump. It feels like you're just going back to what you were trying to escape from, and that just seems so unfair."

"It's so hard and horrible," she says. Her eyes are rimmed with red, and she gives the impression of being constantly on the verge of tears. "You hoped somehow something would happen, you could put on weight and not care, or not look like you looked before.

"But it just feels like a big waste of time and effort. You've sacrificed pretty much a whole year of school, friendships, family relationships. I'm a whole year behind on everything, basically. When I was not eating, at least I was succeeding at something. Now that's taken away, and I have nothing. Absolutely nothing." And she turns away, and returns to her plate of food.

Dealing with eating disorders

Beat, the charity for people with eating disorders and their families, offers a number of resources and training events to teaching professionals.

Its advice includes:


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