An Apple a Day (18 page)

The longer I failed to make progress, the more embarrassing it became. I remember one appointment very clearly: it was my twenty-ninth birthday. I'd somehow dropped a few extra pounds that week—as a birthday present to myself, or perhaps it was linked to me giving up smoking. Apparently cigarettes speed up your metabolism; apparently giving them up makes you feel hungrier
and eat lots and pile on the pounds. Yet, petrified of gaining weight post-cigarettes, convinced that my nicotine-deprived metabolism would grind to a halt, I had been compensating by eating even less than usual. I was half-crazed with Marlboro Light withdrawal, edgy as a junkie, and a few pounds lighter, drifting down under 100 pounds again. At the end of the session as I stood up to leave, Dr. Robinson looked me straight in the eye and said, “It's time to give up the anorexia, Emma. It's time to grow up.” I felt so ashamed.

* * *

Although anorexia is a solitary illness, it's also competitive. Nowhere was that more apparent to me than in the Eating Disorders Unit. Despite being an overwhelmingly female condition, it's not a cozy sisterhood, not like those friendly Weight Watchers groups where women trade dieting tips and fat-free chocolate cake recipes. Of course weight-loss groups may be competitive too, but they seem to foster a sense of camaraderie that has no parallel in the world of anorexia. You gather a bunch of anorexic women together in the depressing lounge of the therapy suite, all purple sofas and “balanced meal” charts on the wall, and they glance at each other—and that's when you feel fatter or thinner, that's when the guilt and the comparisons begin. When I wrote a column one week, warning other sufferers against getting involved in group therapy, I received some fairly vitriolic responses from practicing therapists. I understand—they believe that group settings can be beneficial—but I disagree.

For me, group therapy simply made matters worse. Whenever I tried it, the inpatients would scrutinize me, comparing my level of thinness to their own. I have felt it so many times, that anorexic flick up and down the body, assessing you in one quick glance. To be taken seriously, your thighs must be like twigs, your
arms like matchsticks. Any hint of flesh or softness and you are automatically dismissed. I don't remember anyone ever chatting in the waiting room before or after group sessions. I don't remember meeting anyone's eyes.

Although I may have felt uncomfortable as an outpatient, a fat fraud, I never wanted to be a part of the inpatient world. Those hollow girls were the hard core. Ranging in age from early teens to late forties, they spent every day in the unit. Each meal was measured and monitored, the patients ever vigilant to see who was eating and exactly how much. Every hour of the day was filled with therapeutic activities or group sessions, until your illness became your identity. In my opinion, this is the risk of becoming an inpatient: that soon you have nothing left but anorexia.

Maybe that's why, even when my weight had dropped below 80 pounds, I fought against hospitalization like a drowning cat tied in a sack. I was focusing on my finals at Oxford, then my career: was I expected to leave my job, go into the hospital, and be force-fed? I always felt that becoming an inpatient would be the beginning of the end. Maybe I was wrong—maybe if I'd surrendered to radical intervention at an earlier stage I would be free of anorexia today. But as long as I live, I'll never forget the holocaust levels of starvation I've seen in Eating Disorder Units. (It's been estimated that many anorexics survive on less than 800 calories a day—I've done it myself—which is well below the average caloric intake of a Belsen concentration camp inmate.) If only the psychologists, the art and music therapists, and the dietitians could know what it's like from the inside, how it feels to be in these units, the way their patients constantly look and compare. What could be more dangerous for anorexics than to compare their own body and food intake with other anorexics? This is why I believe that these groups can do more harm than good.

Anorexia is at the extreme end of this spectrum, of course, but it's a spectrum most women are familiar with. We may deny it, but women judge other women's bodies far more harshly than men do, both in the media and in our own lives. I'm not the first woman to point out that most of the female angst about female bodies and weight and appearance is caused by our own or other women's expectations—not those of men. As I've said before, we're our own worst enemies. While we're passing judgment on that extra roll of fat or that dimpled hint of cellulite, men are feasting their eyes on a curvy female figure.

Despite my antipathy to group therapy, I do have friends with eating disorders. I “met” some amazing people on the BBC Health message boards (now sadly defunct), most of whom I'm still in contact with. But although I feel I know them—Sunray and Hannah and Kitty and Vics—I've never met them and I don't want to. The Internet can offer a safe, nonjudgmental anonymity. Others have emailed since I started writing the column, and we “chat” quite openly on-screen: Sarah is head of a global division at a major international bank; Rachel is a mother of three and lives in Birmingham; Cara is a primary school teacher—they're all out there, living their lives with anorexia. I could walk past them in the street and not know them, but we have shared our most private struggles. We couldn't have become that close if we knew each other in person. Anorexia just doesn't work like that. With anorexia, you triumph when others gain weight and you don't. The infamous Gore Vidal quote captures it perfectly: “It is not enough to succeed. Others must fail.” The schadenfreude in anorexia is like nothing else . . .

* * *

As I mentioned before, out of everything I tried, it was therapy with Dr. Robinson that helped the most. Quite simply, it helped me understand, and start to challenge, the anorexic trap in which I was caught. Our sessions taught me that, beyond the simple facts of food and weight, anorexia was serving some kind of purpose for me. Yes, there were benefits, otherwise why would I carry on? I found this troubling to come to terms with at first, that such an idiotic mental illness could possibly confer any benefits . . . but it's true. Even though I claim to hate my anorexia, there must be a good reason why I have not been able to let it go.

At the heart of this struggle is, of course, control. For some reason I don't trust myself or my appetite; I fear that if I “let go” and eat, I'll go wildly out of control. I don't know where this comes from. Anorexia is an excellent way to avoid getting fully involved in life, and a way of being unkind to myself.

This is something Dr. Robinson pointed out to me quite soon after I started attending his clinic. It was a wet and gusty day and I'd arrived by bike, as usual. He asked, casually, whether I ever considered taking the tube or the bus, “Most cyclists give up the bike in the harshest winter months—why not give yourself a break, just when it's freezing cold or raining or snowing out? You could stay warm, use public transport instead.” I looked at him, confused. The thought hadn't occurred to me. And so we began to explore the idea of punishment.

On a bitter winter's morning in London, I would make myself stand under an ice-cold shower. I was still doing that in October, November, right up until I began to turn things around at the end of last year. Why would I do that? Simple: it hurts. It isn't a punishment exactly, but more what the opposite implies: a warm bath or hot shower implies comfort and ease and, yes, neediness. I don't do it so much anymore—part of this challenge has been about learning to be kinder to myself, and I'm getting better at
that—but once in a while, when I'm getting lazy or complacent, I'll remind myself that I'm still sharp with a painfully cold shower, or a day without food. The human need for comfort seems like weakness to me. I am wary of those needs—warmth and food and love—because once you start where does it end? You start to
rely on
softness and company and other people's love. I'm not needy or greedy, I'm fine and I can manage alone. When Laurie left me, I didn't go running to him, begging him to take me back—I just dealt with it. When Greg killed himself—I just dealt with it. No one is ever going to accuse me of
needing
things; I'm OK on my own. People leave you, people die: what can you rely on, really?

Far better to stay on your guard, far better to know that you can cope when things go wrong.

* * *

Turns out there are many ways to punish yourself. For me, running came late on, but once discovered I threw myself into it completely. Dr. Robinson looked concerned when I took up running. My parents didn't like it when I took up running. My big sister looked wary when I took up running. Running was central to my self-punishment regime—and this is why I miss it so much. I remember my last long Sunday morning run, seven months ago now. I was halfway through a fast 10K and overtook some women on the canal towpath running (or rather “jogging') together. I wondered,
Why would you run with someone else?
Why would you choose to share this intense, solitary activity, mile after mile, in sunshine and rain, alone with your thoughts, every step making you leaner, firmer, every mile taking you farther from the lazy, lethargic world? Like writing and eating, I couldn't stand to share my running. It was such a personal thing: a therapeutic punishment, a way to push, push, push myself.

I had stopped smoking one day and started running the next, telling myself it would help me recover, that this new “healthy” regime was a fresh start. I had read magazine articles where former anorexics talked about how regular exercise helped them overcome the illness. But for me, running was absolutely feeding the eating disorder. When I vowed to start eating more then I would run more, five or ten miles in a day, on top of the long bike ride to and from work. Sometimes I would get up at 5
AM
and run through the city, along the Thames, criss-crossing Tower Bridge, London Bridge, Southwark Bridge, Waterloo Bridge.

When Dr. Robinson first told me about “jogger's infertility” I hadn't actually heard the term before but my body immediately got it. Research has shown that the beta-endorphins induced by intense exercise—the endorphins that produce the post-run euphoria—also act to suppress the ovaries. Runners are literally pounding their ovaries into submission. Just what I needed, another way to attack my nonfunctioning reproductive system. He told me about the “athletic triad”: amenorrhoea, osteoporosis, anorexia. Maybe those risks are worth it for an athlete, ballerina, or marathon runner earning her living through this damaging lifestyle, but I'm not.

I don't know why I loved running so much, and I don't know why I took to hunger so proficiently. I have been trying to focus on this and nothing else, to understand why I'd want to hurt myself, what I'm unhappy about, what punishment gives me.

Something about self-denial sharpens my sense of self. And after so long, it has come to define me; this is what I am, this is what I do. Of course there's everything else—my writing, my family, my relationship with Tom, my flat—but the eating disorder is part of my identity. I fear that when the anorexia is gone, something huge will be missing. The logical solution, which I'm trying to talk myself into, is to find something else. If I need to fill the missing gap, fill it with something constructive, something less
self-destructive. In the same way that running replaced smoking, could being a mother replace being an anorexic?

* * *

Despite my skepticism, it turns out that psychological treatment can provide important insights and a level of self-understanding. Now, more than a year since our final session, Dr. Robinson and I are in contact again. After the first column in
The Times
, he emailed out of the blue. When it landed in my in-box, it was like receiving a message from the Queen.

Dear Emma
,

Wow. I was so impressed to read your article, but quite stunned to read that you are going to do it! I can imagine you must feel apprehensive, but it could well work, after so long trying. I wish you all the best in the world—I've even taken out a subscription to
TimesOnline
to follow your progress
.

It still sounds hard for you and I was wondering what doing this in the public gaze does? What it says to me is that the part of you that wants to beat the anorexia is saying, “Get out there and show them!” while the side that still holds onto thinness must be really terrified of that publicity, all that exposure. Demons that visit us in the night melt away with the morning light. Perhaps you are hoping (perhaps with reason) that the anorexia demon will be weakened by being exposed
.

I've got to know so many patients with anorexia (to encourage you, one just sent me a photo of her new baby) and of those who recovered (sadly not all did as you know from your clinic visits), the ways they recovered were really diverse. One set her sights on a job and knew that the anorexia was standing in her way. Another wanted to be a mother and managed to overcome some awful experiences from adolescence and move on. The most remarkable
was a woman in her forties who had anorexia since nineteen and had nearly died from starvation. She started putting on weight and completely recovered over about a year. I asked her what had made the difference. She said, “Do you remember me asking you, ‘How can I escape from this awful thing?' and you said, ‘Why don't you try eating a little more?'” I don't know what to make of that, but maybe she needed permission to feel less guilty about satisfying her hunger
.

After having heard all these thousands of stories I (shamefully) still can't answer the question about what works. Sometimes I think that anorexia is a circuitous route through a minefield. The mines differ for each person. In some they are memories of abuse, in others, diverse traumas. Sometimes you get free of the minefield and can walk straighter; some, sadly, don't. I'm sure in many cases we don't even know what the mines are, and maybe they are, or become, imaginary. I would suggest that that might be the case with you, Emma. If the anorexia is a cupboard you are sitting in to avoid the dangers outside, perhaps the only way to find out if they are real or not is to come out of the cupboard and see. You may well find that your imagined demons dissolve when you work up the courage to face them
.