A Disorder of Mind and Body

4 December 2012

Consistently taxing, occasionally distressing, but always inspiring. Jethro Thompson has first-hand experience treating a much-misunderstood type of affliction: eating disorders.

When I tell people that my summer job is working on a ward for eating disorders, I invariably get one of two responses. “But you’re an English student!” is probably fair enough. More commonly, however, I am faced with “that sounds grim.”

It’s not grim. It can be taxing, at times distressing, but “grim” implies a uniform grey, stifling atmosphere of depression which I’ve not encountered. People do get better and make full recoveries. To bite the cliched bullet, working on the unit is interesting and rewarding too. Coming to university means that I am away from the ward for months at a time and returning in the next vacation and meeting patients who are noticeably recovering can be truly inspiring.

Eating disorders, particularly anorexia nervosa, are terrible illnesses that attack a person on all fronts. When the body is starved, the brain shrinks and basic comprehension is impaired, major organs are wasted away and bone density drops irreversibly. The solution can seem so simple: “just bloody eat.”

Every case is complex and different, however. For someone with an eating disorder, there are four main behaviours that can contribute to weight loss: restricting food intake, vomiting, laxative abuse and excessive exercise. A sufferer may feel overwhelming compulsion to engage in one or more of these activities.

Eating disorders can also be accompanied by other mental health problems – depression is common and personality disorders can make treatment difficult. Many patients I’ve spoken to have described an internal ‘voice’ (though not literal auditory hallucinations) that produces and feeds on a patient’s doubts and fears concerning eating. It often manifests itself in physical delusions – a sufferer might pinch skin on an emaciated arm and view it as evidence of obesity. In fact, almost every patient considers themself to be the biggest on the unit, even though many can easily recognise the effects of malnutrition and need for weight gain in others.

The causes of anorexia nervosa are as varied as its symptoms. Someone in a difficult or stressful situation, perhaps caught in the crossfire of family rows at home or drowning under pressure at university, might turn to eating disorder behaviours as a means of establishing control over some part of their life. The influences of the media and the fashion industry have an impact, particularly for those attempting a career in modelling. Certainly, our culture has a damaging obsession with thinness and weight loss, but as a cause of eating disorders this factor is often overstated.

Where I work, each patient (and member of staff) makes their own laminated placemat covered in pictures of family, friends, pets and motivational messages to have something comforting and personal as a distraction during mealtimes. When a patient is discharged, their placemat goes up on the wall as a very real reminder of the patients that have recovered and left the unit. There is a temptation to be demoralised when you spot the past mats of a current, returned patient pinned up, but readmission and relapse doesn’t mean full eventual recovery is impossible.

Working on the unit for a while has opened my eyes to the ways in which an eating disorder can have a knock-on effect on every aspect of a person’s life. Watching television becomes an opportunity for exercise by jiggling one’s legs. Cookery programmes are watched obsessively and endless recipes noted down. Excuses are made to attempt to avoid the snack where Hula Hoops are on the menu – marketed as containing 25% extra in the packet. Things that seem petty get blown out of proportion as patients struggle for control in any way possible. The staff find affectionate terms for such incidents, like ‘Cappuccino-Gate.’ Chatting about certain topics can act as a trigger for some patients, so it is important to be aware of this and steer table talk away from conversational minefields.

The patients might take every opportunity to outwit a new and unwary member of staff. Offer a selection of yoghurts and the rhubarb will invariably be chosen – it’s got one less calorie in it. Offer an after-dinner mint and they will be clandestinely swapped around. Patients might secrete a bottle of contraband Diet Coke in the bushes outside the hospital, persuade a visitor to smuggle in a Twix or drink copious amounts of water the night before being weighed. Listen carefully, and you might pick up the light patter of star-jumps in a locked bathroom or, after buzzing a patient out for a walk, hear the sonic boom as they accelerate into a speedy march.

The prognosis for eating disorders is good, better if it’s the first instance of the illness and better still if treatment begins early. University life can be stressful and overwhelming and it is in such environments that eating disorders can develop, particularly when a person moving away from home for the first time suddenly has far more control over their diet.

In Cambridge, the University Counselling service can help and Addenbrooke’s has a specialist unit for eating disorders. The illness is powerful and destructive and in serious cases sufferers find it hard to separate themselves from the eating disorder. One patient told me that they had nothing else in their life, but that doesn’t have to be the case and thankfully it rarely is. Anybody with an eating disorder is, first and foremost, a person. People have ambitions, plans, ideas and a sense of humour and kindness and it is this that means that my work is never “grim.”