Thin (30 page)

I wish I could swim out to find you, and that you would listen to me, and that we could both come back to shore together. This is what I wish. But I think that if I came near, you would only swim out further, in a panic, fearing that I might make you do something that you are not ready to do. I can only show and tell you my own story from afar, hold it up for you, and hope that you might not have got so deep into things, that you may just be able to pull yourself out. I have been sharing my story so that if you want, you can listen, and you can maybe try to reach out your hand for some kind of a float. There are so many things I would like to say to you, but even I would not know where
to start. I feel that I should be able to better explain it, but that is the agony of this thing; it sort of seizes you up and freezes you out. Can you feel that? That is why we talk in metaphors because we don’t want to admit to the reality of it. And we feel that it is easier that way, don’t we?

So instead I have made this story of my real and honest memories; more honest than I thought possible. Things are living in vivid, out-loud colours. Secrets from below the surface are on display. Maybe something will make sense for you, and you will start to see how things can change. There are ways out. There are endings. You don’t have to sit with it for years. But you can’t do it all on your own, sometimes you need someone to help. All you need to do to start off with is to put out your hand and ask for someone else’s. Don’t drown. Fight it. Come with me to

The End.

1
Prevalence figures for eating disorders in the UK (diagnosed and undiagnosed): 1.15 million people, Eating Disorders Association [EDA] website
www.edauk.com
(27 August 2004, Norwich, UK).

2
‘Doctors say sufferers are attention seekers’. An article on the findings of the EDA research, ‘Getting Better? Is the quality of treatment for eating disorders in the UK getting better?’
Observer
(6 February 2005).

3
Diagnostic criteria for eating disorders, American Psychiatric Association (Diagnostic and Statistical Manual, DSM IV, 1994).

4
‘The most commonly used proxy is 10 per cent of all cases of eating disorders will be male’ (EDA, 2000), EDA website
www.edauk.com
(27 August 2004).

5
‘The average age of onset for anorexia nervosa has been reported to be between 16.6 and 18.3 years’, Theander, 1970; Halmi, 1974; Crisp et al. (1980), EDA
www.edauk.com
(27 August 2004).

6
Article in the
Daily Telegraph
, 8 March 2005, quoting Dr Andrew Hill, Senior Lecturer in Behavioural Sciences at Leeds University Medical School.

7
A. H. Crisp,
Anorexia Nervosa: Let Me Be
, Psychology Press, 1995.

8
Susan Willard, NOVA/Transcripts: ‘Dying to be thin’,
www.pbs.org/wgbh/nova/transcripts/2715thin.xhtml
, (WGBH Educational Foundation and Twin Cities Public Television, 2000).

9
Forty-two per cent of GPs did not make an early diagnosis, ‘Getting Better? Is the quality of treatment for eating disorders in the UK getting better?’, EDA (7 February 2005).

10
Fifty-five per cent of people are not being treated by a specialist, ‘Getting Better? Is the quality of treatment for eating disorders in the UK getting better?’, EDA (7 February 2005).

11
Anorexia nervosa has one of the highest rates of mortality for any psychiatric condition: 13–20 per cent per annum, Howlett et al. (1995), EDA website
www.edauk.com
(27 August 2004).

12
P. F. Sullivan, ‘Mortality in anorexia nervosa’,
American Journal of Psychiatry
(1995), 152 (7), 1073–4. Cited in ‘In-Patient Versus Out-Patient Care For Eating Disorders – A West Midlands Development and Evaluation Service Report’ (Development and Evaluation Service, Department of Public Health and Epidemiology, University of Birmingham, 1999).

13
A. H. Crisp,
Anorexia Nervosa: Let Me Be
.

14
‘Hilde Bruch argued that anorexia nervosa is caused by the failure to develop a diverse set of identities and self-definitions’, Karen Farchaus Stein, PhD, RN and Linda Nyquist, PhD, ‘Disturbance in the Self: A Source of Eating Disorders’, article from
Eating Disorders Review
(January/February 2001), vol. 12, no. 1 (Gurze Books, 2001).

15
‘Disturbance in the Self: A Source of Eating Disorders’, Karen Farchaus Stein, PhD, RN and Linda Nyquist, PhD, article from
Eating Disorders Review
(January/February 2001), vol. 12, no. 1 (Gurze Books, 2001).

16
‘Family studies have shown the prevalence of eating disorders is 7 to 12 times higher among relatives of anorexic or bulimic probands than among controls’, ‘Serotonin: Implications for the Etiology and Treatment of Eating Disorders’, Walter H. Kaye and Michael Strober, PhD,
Eating Disorders Review
, vol. 10, no. 3. (May/June 1999).

17
Walter Vandereycken and Ron Van Deth,
From Fasting Saints to Anorexic Girls: The History of Self-Starvation
, p. 4, (The Athlone Press, 1994).

18
Yogarexia, reported in the
Guardian
Weekend (26 February 2005).

19
David Knight and Steven Bratman,
Health Food Junkies
: The
Rise of Orthorexia Nervosa – The Health Food Eating Disorder
(Broadway Books, 2001).

20
Stressorexia, reported in the
Independent on Sunday
(5 December 2004).

21
‘Whilst the incidence of anorexia nervosa appears to have remained fairly constant over time, that of bulimia nervosa appears to be increasing rapidly. Turnbull et al. (1996) have suggested a fivefold increase in the incidence of bulimia nervosa over a five-year period from 1988 to 1993’, EDA website
www.edauk.com
(27 August 2004).

22
Richard Morton’s
Phthisiologia; or, a Treatise of Consumptions
(translated from the original 1689 Latin edn, London, 1694), in which he describes ‘Atrophia nervosa’: to waste away from nervous consumption.

23
The New Shorter Oxford English Dictionary
.

24
Dr Ernest Charles Lasègue, ‘On Hysterical Anorexia’, translated from
Archives Générales de Médecine
(April 1873),
The Medical Times and Gazette
, 2, (London, 1973). Quoted in
From Fasting Saints to Anorexic Girls: The History of Self-Starvation
, Walter Vandereycken and Ron Van Deth, p. 157 (The Athlone Press, 1994).

25
Anorexia Nervosa: Let Me Be
, A. H. Crisp.

26
Charlotte Brontë,
Shirley
, World Classics, 1991.

27
‘One in every 250 females experiences anorexia in adolescence and young adulthood, and five times that number suffer from bulimia’, National Institute for Clinical Excellence (2004). Eating Disorders. NICE Clinical Guideline No. 9, London, National Institute for Clinical Excellence. Available from
www.nice.org.uk
.

28
Russell, 1979: Fairburn and Cooper, 1984, Mitchell et al. 1986, EDA website
www.edauk.com
(14 November 2004).

29
‘Bulimia Nervosa was not recognized as a clinical condition until Gerald Russell’s paper, published in the UK in
1979’, EDA website
www.edauk.com
(27 August 2004).

30
‘Eating disorders can persist throughout life and people may fluctuate between anorexia and bulimia nervosa’, EDA website
www.edauk.com
(27 August 2004).

31
Diagnostic criteria for eating disorders, American Psychiatric Association (Diagnostic and Statistical Manual, DSM IV, 1994).

32
A. H. Crisp,
Anorexia Nervosa: Let Me Be
, p. 33.

When I was anorexic, I really liked reading about anorexia. Unfortunately, it was often for the wrong reasons, and encouraged my disordered behaviour. As I began to recover, however, I found inspiration and guidance within those same words, which I hadn’t been able to see before. The very fact that my illness was being discussed and analysed helped me to see beyond myself. I believe that all the books I have listed here have clearly good intentions behind them. They offer practical advice, useful information or personal or historical viewpoints on the illness for the benefit of others.

Chisholm, Kate,
Hungry Hell
, Short Books, 2002.

A clear and concise account of the author’s own experience of anorexia, balanced out with informative historical and theoretical sources.

Hornbacher, Marya,
Wasted
, Flamingo, 1998.

American writer’s brutally honest memoir of her experience of eating disorders. Her powerfully punchy writing engulfs the reader into the very extremes of her illness. This is a no-holds-barred tale of her struggles, which had very severe effects.

Lindsay, Clare,
Conquering Anorexia: The Route to Recovery
, Summersdale, 2000.

An accessible, simply written diary account of anorexia, and
the author’s experience of differing treatments, including a useful section on self-help techniques and exercises for those looking for help with recovery strategies.

Cooper, Peter, and Fairburn, Christopher,
Bulimia Nervosa and Binge-eating: A Guide to Recovery
, Constable & Robinson, 1993.

This guide is suitable for sufferers and their family and friends. It contains a wealth of information to aid understanding and discusses treatment options. Part Two of the book offers a self-help programme with effective strategies for beating the problem.

Crisp, Arthur, Joughin, Neil, Halek, Christine, and Bowyer, Carol,
Anorexia Nervosa: The Wish To Change
, Psychology Press (second edition), 1996.

Dr Crisp is a leading expert on anorexia. This book provides a step-by-step programme for change for those suffering from anorexia. It would be most effective for those already committed to trying to combat their anorexia, but unsure about how to start.

Fairburn, Christopher,
Overcoming Binge Eating
, Guilford Press, 1995.

Includes clear information about eating disorders and a comprehensive self-help guide for recovery from binge-eating disorders.

Freeman, Christopher, and Cooper, Peter,
Overcoming Anorexia Nervosa: A self-help guide using Cognitive Behavioural Techniques
, Constable & Robinson, 2001.

This is a complete self-help recovery programme to overcoming anorexia using cognitive therapy techniques.

Treasure, Janet,
Breaking Free From Anorexia Nervosa: A Survival Guide for Families, Friends and Sufferers
, Psychology Press, 1997.

This often recommended book aims to answer questions raised by the illness for a variety of readers. It includes an overview of anorexia, different perspectives on the illness, and reassurance and guidelines for professionals, patients and their families.

Brontë, Charlotte,
Shirley
, Oxford World Classics, 1991.

Female starvation hinges on the line between power and powerlessness in this nineteenth-century novel.

Hamsun, Knut,
Hunger
, translated by Sverre Lyngstad, Rebel Inc., 1996.

A captivating, hugely original and sometimes disturbing novel written in 1890,
Hunger
is an interior monologue of a young male writer suffering from the extreme effects of starvation, desolation and loneliness.

Rosen, Jonathan,
Eve’s Apple
, Granta, 1997.

Observed from the perspective of an anorexic’s male partner, this novel offers intelligent insights into the nature of appetite and obsession.

Duffy, Carol Ann,
Feminine Gospels
, Picador, 2002.

This compelling book of poetry focuses on various shapes and forms of female identity.

Bruch, Hilde,
The Golden Cage: The Enigma of Anorexia Nervosa
, Harvard University Press, 1978.

This classic text from the 1970s still provides insight into the illness for patients, parents, mental health trainees and senior therapists alike. Bruch focuses on the pursuit of thinness and the formation of identity.

Crisp, Arthur,
Anorexia Nervosa: Let Me Be
, Psychology Press, 1995.

A clinical perspective on anorexia nervosa, Dr Crisp’s focus is that of the development of the illness and the challenges posed by puberty and growth. This book is suited to those with a professional interest in the subject, or to parents or sufferers who value a more in-depth and detailed clinical approach.

Duker, Marilyn, and Slade, Roger,
Anorexia Nervosa & Bulimia: How to Help
, Open University Press, 1988.

This book is intended for helpers and carers of all kinds who are concerned with the best methods to help. Describes what that help can involve, drawing upon the authors’ own experience with clients.

Lawrence, Marilyn,
The Anorexic Experience
, Women’s Press Handbook, 2001(first edn 1984).

An informed perspective from a therapist at the Women’s Therapy Centre, this is a clear and accessible guide to approaching the illness.

Orbach, Susie,
On Eating
, Penguin, 2002.

A helpful guidebook from the author of
Fat is a Feminist Issue
,
this little book offers tips and pointers on redressing your relationship with food and eating. The advice is clear, easy to digest and calming.

Schmidt, Ulrike, and Treasure, Janet,
Getting Better Bite by Bite: A Survival Kit for Sufferers of Bulimia Nervosa and Binge Eating Disorders
, Psychology Press, 1993.

A useful manual offering help to those with bulimia and binge-eating disorders. It provides suggestions for further reading as well as advice on a wide spectrum of relevant topics.

Wurtzel, Elizabeth,
Prozac Nation
, Quartet Books, 1995.

A powerful account of living with depression and self-harm embedded with an astute cultural awareness of America at the end of the twentieth century.