Tag: Anorexia

Force Feeding The Anorexic

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Anorexia And “Force Feeding”- Self Determination Or Self Annihilation

A while ago I was listening to LBC radio. The subject was  a decision in favour of the so-called force feeding  of patient E.  On Saturday Norman Lamont suggested that the decision to force feed could be an intrusion on her right to self determination . What complicates this case is that the parents of this young medical student,- anorexic since eleven  years of age-wants their daughter to be left to die with dignity.

There is nothing dignified about anorexia or any other mental health condition for that matter. Also, I just wish that people would STOP using the term “force feeding”, which reminds us of the traumas inflicted on suffragettes on hunger strike to obtain the vote for British women. I just wish that people would use the proper term, which is ENTERAL FEEDING.

Many clinicians have been writing in favour of the judge’s decision on Linked In.  We talk to each other about things we know, which is that low weight impairs the ability to think clearly. That at low weights the anorexic voice drowns out logic, reason and happiness.

But not-one said it better than Kate, who came nervously to the radio to express her point of view. Kate has been anorexic since age 9 and in hospital many times during her young years. She said “I have no idea why I just didn’t want to eat, but I didn’t, and there were times when I would have been very happy to just fade away.

But they didn’t let me, and there were times when I was on a section and they threatened me with the tube…. No it wasn’t a threat, it was just something they said would happen but it felt like a threat at the time. Having no control over what they put in it was the worst thing imaginable for me.

But I somehow got to the age of 20 and I said to myself, I’m sick and tired of this anorexia. It took 11 years for me to admit I had a problem. So I made myself start to eat. I’m 24 now and life is so much better.  Life isn’t a bed of roses but anorexia is very hard work; and I had enough.

I spoke to my father about it and he admitted that he had something like me when he was in his teens, but being a man nothing was said or done about it.”

The interviewer asked, “Everyone is saying that it’s all the pressure on young girls to be slim, in magazines and so on?”

“Oh no”, she said, “When I was nine I hadn’t even seen a magazine. It’s nothing to do with magazines and models, it’s just the way the brain is wired”.

So there you have it from the people who really count. Clinicians know very little. Listen to the people who have looked into the pit and been dragged into the light, kicking and screaming. At all costs we have to arbitrate in favour of the wish to live.

Does Anorexia Ever Really Go?

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In the Times way back in August 2013 Lizzie Porter wrote movingly about the after-effects of the illness, which are still with her.

In her book about Anorexia, Emma Woolf also writes movingly about her struggle to get well. Despite being able to move away from the cachexia of severe anorexia, she documents in her column An Apple A Day how residual anorexic thinking prevents her from being able to eat cheese. Her recovery  is conditional upon maintaining an orthorexic relationship with food.

I was, oh so briefly anorexic  years ago, and now I eat a very broad diet. Only yesterday  I dug happily into  a meringue made by one of my friends. I stir fry quite a lot of food. I have butter on my jackets.  But I do eat more healthfully and in smaller quantities than most of my friends.  Even now, after all these years,  you won’t see me tucking into the canapes at parties. I drink very little alcohol and rarely want  dessert, only ice cream, perhaps one boule.  I eat cheese although dainty little chunks. I’m not very interested in food.  Am I just looking after my health, or, does anorexia ever really go?

Lizzie Porter’s account of her 10 year struggle with anorexia needs to be read by all eating disorder professionals who feel stuck after working with a young patient for 2 or 3 or even 10 years.  While it is clearly a mental disorder, the manipulation of food has very physical effects. Perhaps the physical effects of eating trump the emotional ones and make it easier for someone to become or stay anorexic rather than  depressed or psychotic. Lizzie writes about all the medicines she has to take to manage indigestion, cramping,  bloating and nausea. Is this an effect of the anorexia or did it make the anorexia happen?

In my case for example, from as early as I can remember, I couldn’t eat large platefuls of food. The usual party food loved by kids made me queasy when I was very young.  I was only interested to eat fish and chips when I went out.  I only wanted to drink milk or bitter lemon. I couldn’t stomach biscuits or coloured ice creams. Unlike other kids, I was not interested in food. My tummy is very unhappy if I eat a lot of fat or drink more than half a glass of wine. That was there before I had any concerns about weight.

Lizzie says that the anorexia is still with her long after therapists think her treatment is done. Until recently she says, the idea of sex was repulsive but she seems to have dragged herself out of that. What an effort everything is for her, although outwardly she seems to be successful, she is still secretly weighing food and scheduling her day around mealtimes.  She wishes to be free of the fears  of food and its effects  like occasional dizzy spells while and enjoys being thin.

I would say to Lizzie that anorexia never really goes, but as one gets older, one becomes more forgiving.  We learn to be “anorexic” and also well. We can learn to live without thinking about food at all. We can have fat moments and fat days and give them no attention at all.

So to therapists who agonise about the extent to which someone is stuck with their anorexia I would say this. If the patient is bulimic, they need constant care since they are those most likely to be very, very sick.  But if  your patient is safe and functioning reasonably well, endless therapy probably isn’t going to do much at all other than provide the illusion that something is being done.  Anorexia isn’t a quick fix, a life sentence or something that has to be chewed on by well meaning therapists until someone is maintaining a totally normal weight .

Many therapists might disagree with me and argue in favour of treatments that represent a complete cure. This is ideal, but is it possible if anorexia doesn’t really ever go?  I’ve met some eating disorder experts running well known treatment services who are still extremely thin.  YES,  YOU KNOW WHO YOU ARE…. They argue in favour of health. But has their anorexia ever really gone?