Sick to death of the pressure to be thin
I can pick out a teenage girl who is being sick and disguising it. My daughter Katharine has shown me how skilled she became at putting food into her mouth, chewing it, taking it out and hiding it - and all that in front of a nurse who was there to observe her eating.
I do not blame the nurse in any way. It is a barely understood condition. Reactions to it are not unlike those to Aids when it first aroused universal fear. Medical people and the caring professions have only just begun to scratch the surface of their understanding; in social terms, I know the parents of anorexic girls who have been cruelly ostracised by friends. It really is that bad.
There is a temptation to go for the quick fix, to find the simple solution, but anorexia is not that simple. The psychiatrist who saved Katharine's life talks of the pressures on young girls, and of the cynical popular message that to be thin is to be acceptable.
Self-esteem is undoubtedly a key factor but other causes come into play and each case is different. Girls with anorexia are feeling the delights of control and manipulation for perhaps the first time in their lives; it is often a response, an angry response in the only way they know how. The complexities of life are reduced to a single issue - eating.
That same psychiatrist talks in chilling, pragmatic terms about an epidemic of anorexia waiting to happen; I am not sure that schools and the health professionals are prepared for it. Inevitably, there will be tragedies. This condition cannot be counteracted with a day's awareness training and a staffroom booklet. It is striking just how many people know of someone who suffers or has suffered from an eating disorder. According to the latest edition of Population Trends, the incidence is highest among middle-class schoolgirls with 10 in every 1,000 suffering anorexia.
In my part of the country - West Yorkshire - the prevailing opinion is that a major cause is family dynamics. Initially, we were referred to a unit where the entire family is taken to an interview room where two psychiatrists wait.
It's a humiliating experience and potentially damaging for everyone because blame immediately comes into the conversation and people start feeling guilty. Brothers and sisters are then placed in grave emotional danger. Had we persevered with that form of treatment, we would have found ourselves being interviewed by a larger team of psychiatrists, being observed by some more through a two-way mirror. I have spoken to parents who have been through that ordeal and their lives will never be the same.
Had we indeed persevered with that treatment, I believe Katharine would have become a statistic, one of the two out of 10 teenage anorexics who die.
I felt angry because no progress was being made. There was no attempt to find ways of stopping Katharine making herself sick. The unit psychiatrist was blithely arranging meetings a week or a fortnight ahead. In the meantime, my daughter's weight was shrinking by the day and she was fast approaching starvation level. Last August I waited at home one afternoon for him to ringIhe did not make that call and has not communicated with us since.
My daughter was at a boarding school in York. Senior teachers at the school alerted us to her sudden, drastic weight loss and we approached the school doctor for help. At our insistence, she recommended that unit.
But she never once mentioned The Retreat, a hospital in York where eating disorders are treated successfully. A desperate conversation with one of her colleagues led to an appointment where I met the psychiatrist from the Retreat whose sharp analysis and admirable patience eventually saved Katharine.
Katharine almost died during the next few months. She was in grave danger for some time but rallied with care and help. We met others who were suffering, women who have been struggling with the ravages of anorexia for 20 years and more.
There is an obsessive fear of food which dominates the victim's every waking moment. The grip of anorexia tightens as meal-times approach so that, instead of enjoyment, there is anxiety and dread.
Anorexics will count peas, negotiate over mouthfuls and take excruciating lengths of time to eat their food. They have an astonishing knowledge of the calorie and fat content of any food placed before them. Fear of weight gain and "fattening-up" peppers their conversation. When I took my daughter out for a short walk - short was all that she could manage - we met someone in a shop. The woman told her how well she looked.
That did it. To my daughter "well" meant fat and fat was not acceptable. The clouds descended for the remainder of the day.
When weekly weighing sessions were established, Tuesday, the dreaded day, was treated with terrible foreboding. A weight gain of even half a pound required much supporting conversation with nurses. If there was a weight loss, the belief that "I could lose some more, quite safely" had then to be negotiated.
Early awareness of eating disorders is essential. Signs include reluctance to eat, obsession with diet and repetitive exercise. Beware of youngsters buying slimming pills and laxatives. Visits to the toilet soon after a meal and large-scale drinking before a meal are sure signs, as is a sudden reliance on paper hankies - a good way to dispose of unwanted food!
Parents need support and steering in the direction of medical help. The best form of support is talk and, more especially, talk with parents who have experienced the horrors and the feeling of helplessness.
Schools really should make it their business to know where eating disorders are being treated locally. Apportioning blame and guilt ought to be avoided, and any reasoning left to professionals with experience.
When a victim has recovered enough to get back to school, some big decisions will have to be made. Put a recovering anorexic back into the situation she was enduring when the condition first became apparent, and anorexia will return. She will not want to live through the memories, to go into toilets where she regularly made herself sick. Anger will show itself in the only way she knows how - being sick.
A change of scene is now essential for Katharine. The help and understanding we received from her boarding school couldn't be faulted but a fresh start was essential. The immediate future is a day school near home with a day a week at The Retreat to continue the support she has been used to. Her link with The Retreat, we are told, will have to continue for at least six years. She starts a new school in September and is full of optimismIbut only last September she had no future.
Kevin Berry is a teacher and writer from West Yorkshire.