Refused “to maintain weight at a minimal normal level for height and age, such that the body weight is 15 per cent below that expected for the individual’s height and age”.
Had “an intense fear of gaining weight and becoming fat”.
Had “a distorted notion of body shape and image”, such that I “continued to complain of feeling fat even at a very low weight”.
Had amenorrhoea (abnormal absence of periods).
I was no longer just a teenage girl playing with her food; I was now in a completely different territory. In post-pubescent anorexics, weight loss can be a physical manifestation of the rejection and fear of growing up. During puberty, the body changes. In girls, body fat increases to provide the tissue for fertility and menstruation. Anorexia forcibly stops this growth and reverses it; the body slides back to a pre-pubescent state. Physically, the anorexic is stating that she doesn’t want to be, or look like, an adult.
In my case, at 18, I suddenly didn’t feel right about the impending adult changes in my life. Soon I’d be leaving home and going to university. I felt there would be no going home to my own bed, in my own home, where I had lived all my life with my brother and sisters and my mum and dad. I felt like things were moving and growing, and I wasn’t sure I was ready to grow with them. Whereas some people, when they are dealing with adolescence and growth, go out and rebel, or become moody, smoke, drink or take drugs, I did not know what to do, I did not know how to react. I did not feel that I should react, being the gold-starred girl that I was.
There was a vulnerability within me which meant that I was less able to deal with taking ownership of the changes within me than other people going through the same experience. A flicker of my fear turned to action and into a controlled, rigorous diet. The initial diet, I thought, was a means to lose a bit of weight but, in fact, it became more about evading the pressure in my life. Focusing on my gradual path to self-starvation made me feel better temporarily and therefore, I thought, better able to deal with my life.
The question is then why did I, and why do many others, use self-starving as the supposed answer to that uncertainty? A part of this answer tends to come straight to the issue that in our society being thin means being popular (very important to a young person). The answer to all the growing-up issues is simply and neatly packaged in a smaller, more slender body. It is an answer that is also dangerously internalised. A diet might be discussed, but anorexia is rarely something shared with friends. It is a secret, personal and private territory of the body.
Many teenagers seem to identify with the sense of cerebral and bodily enclosure that anorexia effects. Some anorexics have written about how special they think they are and how anorexia has answered their feelings of being detached. I think this has led to a horrible glamorisation of eating disorders and of being young, thin and aloof.
For me, the best explanation is that one day my view of the world changed. I suddenly had a concept of the presence of myself, and a raft of emotions with it, and I didn’t know how to handle it. What I knew, what I believed in and trusted, was the home that I grew up in, the family I was nurtured in and the small town that cushioned me. Then, all of a sudden, I felt transplanted. It was all too much: and so I disengaged with feeling. It was not conscious. It was not like I made a choice to starve myself based on a considered self-awareness. I was just struggling to find my place, like anyone experiencing change, and nothing seemed certain any more, except what I did or did not eat.
My anorexia did, on one level, start with a diet, but it quickly turned into an addiction. One minute I was counting Easter eggs and the next I began a path to self-destruction. Something happened, something clicked when my relationship with food changed from one of routine and normality to one of denial and control, and it spiralled from there. Food, and my focus on avoiding it, was suddenly an all-consuming obsession. My immense, and often overwhelming, hunger for success, perfection and achievement was forcibly quashed by this new focus on the suppression of my appetite. The more I fought my hunger for food, the more my desire for everything else disappeared. Suddenly I was totally trapped and addicted to this new relationship with food.
Being anorexic means being constantly fixated with food: it takes over and, crucially, it doesn’t stop. This is why the definition of anorexia nervosa – the absence of appetite – is so misleading, because it is in fact a continual, endless and ever-present obsession and interest in food, body and weight. The appetite is there, most definitely – it is just too dangerous to let loose, and so every energy is focused on stopping it.
Most importantly, what happens at the start of an addiction to not-eating, and in my case, to a restrictive eating disorder, is that it seems to act like a panacea. I felt better when I ate less. My addiction to food was actually an addiction to feeling better, to feeling fixed. I actually had very low self-esteem, in common with many people who develop anorexia. Beneath layers of the achieving Grace, there was a lack of self-confidence. It so happened that food restriction was the mechanism that initially helped me feel less fragile, and triggered this change of mood inside.
This is the high – every addiction has one – something that makes you feel good, something that is worth the low, or so it seems. Initially, my addiction brought me the power and pleasure. With each new shape I made for myself, I was more optimistic, more alert, more euphoric and more in charge. I ended up feeding only from my addiction. I was surging off the highs that my super-control gave me.
POWER AND CONTROL
Those suffering from eating disorders often feel powerless to its effects. At the same time, however, they also feel a sense of immense control over their relationship with food. Whereas other issues and decisions might seem overwhelming, food is manageable and can be manipulated. My food patterns gave me comfort – there were answers to problems. The more I restricted myself, the more I sensed my own power.
My memory of this time is dominated by impressions of figures from outside my anorexia trying to disrupt my self-control. There was a constant intrusive presence of psychiatrists and nutritionists, family and friends, intent on taking away my internal power, focusing on spoiling the lines of the character of Grace I had so neatly sculpted. And because none of us had the same shape in mind for the outcome of things, I used whatever power I had to fight them, not the anorexia. I drew an invisible circle around myself. If I didn’t share anything of myself – no words, no thoughts – then I was convinced that I could continue on my own.
The amazing thing about the initial stages of anorexia is that is does seem to imbue you with a false surge of physical power. In eating less and less, it appears that you have more energy. The restlessness and the anxiety, which come from the hunger, translate themselves into a jittery, edgy, get-up-and-move impulse, which only drives you further. Then, all of a sudden, the illness begins to consume you, and so you become encircled by it, by a fear of losing control, a fear of letting go of this hold over your weight, over food and over everything. So instead of empowering you with a total control of your every move, the reverse happens. You look like a child, you appear childlike, and so that is how you are treated.
Some theorists believe that there are personality traits that many people who develop anorexia nervosa have in common. One of these is a wish to please their parents and be universally liked. A result of this is that they have not allowed themselves, or been allowed, to express feelings of anger or upset. Many parents of anorexic children will say that those children were obedient, quiet, good children when they were younger. That goodness, which the anorexic feels is so much a part of everyone loving her, means that she will do anything to keep up a polished exterior. Because of this, the anorexic chooses a silent and secretive way of demonstrating her feelings; she keeps her secret starving to herself so as not to displease. She makes a statement, she thinks, in the quietest way possible. But more talking is actually done through this act than has ever been done before. She slowly tips the balance of power; she asks to be recognised. “Confront me and my power on show,” she challenges. “Witness me,” she says.
I did this. I asked my family and my friends to watch me self-destructing. I suppose – without knowing – I wanted to tell them that I couldn’t cope, but that I was not sure why I couldn’t cope or what the problem was. I needed somebody’s shoulder to cry on, but I did not want to cry out loud. I was so proud of my status, my achievements and successes that I did not want to admit any fallibility. But I was also forcing a confrontation. I was refusing to eat their food.
The hardest thing must have been that they were not able to give me a plaster or a bandage; instead they had to watch me be ill, and not do anything immediate about it. Inside their heads, and in the meetings with the psychiatrists, nutritionists and family therapists, and in endless conversations with friends, with experts, how they could help.
The consequences of the illness are potentially enormous; anorexia has the highest mortality rate of any psychiatric disorder. This is not a shock statement, it is a reality; up to 20 per cent of those seriously affected die.
Like 19th-century hunger artists who starved themselves and then displayed themselves as living skeletons, gawped at by people who paid to see these miraculous figures on show, I made my body into a performance.
“Here I am.” I didn’t say, “starving myself”. “Here I am.” I didn’t add, “not eating my dinner”.
“And now for my final trick of the evening – 200 sit-ups on a totally empty stomach/body. Thank you, ladies and gentlemen, mums and dads, boys and girls, and goodnight.”