0:00:02 > 0:00:04Would you have known I was anorexic if you saw me in the street?
0:00:04 > 0:00:07I don't know how to judge that. Am I supposed to say yes or no?
0:00:07 > 0:00:09- I don't know.- I want you to say yes.
0:00:09 > 0:00:11If you say "I didn't,"
0:00:11 > 0:00:14then I would just stop eating again, until you say yes.
0:00:14 > 0:00:16So that's why I'm not going to answer that.
0:00:16 > 0:00:19- I know, I noticed that. - I don't want to play that game.
0:00:19 > 0:00:22- Yeah, it's a game.- Just by having this, you know, fleeting encounter,
0:00:22 > 0:00:24I've sort of been...
0:00:25 > 0:00:28..sucked into this psycho drama.
0:00:28 > 0:00:31Things that would be ordinary conversations, suddenly are charged.
0:00:31 > 0:00:34You know, I might say something that could make your illness worse.
0:00:34 > 0:00:37You could say something that could stop me eating for a week.
0:00:37 > 0:00:40You could say something that will stop me going out for a week and not
0:00:40 > 0:00:43realise you said it, but that's not your fault.
0:00:43 > 0:00:45I'm the one with the problem, not you.
0:00:50 > 0:00:55I've been spending time among people afflicted by a most mysterious
0:00:55 > 0:00:57and sometimes fatal mental disorder.
0:01:02 > 0:01:07Anorexia, a pathological fear of eating and gaining weight.
0:01:08 > 0:01:10I can't see a future.
0:01:10 > 0:01:14- Why?- Because I don't think I'll be alive long!
0:01:14 > 0:01:17I was hoping to get some insight into its causes.
0:01:18 > 0:01:20How it affects patients and families.
0:01:20 > 0:01:23- SHE SOBS - Sh, sh, sh.
0:01:23 > 0:01:27And, with a bit of luck, some understanding of a way out.
0:01:27 > 0:01:31The only way is up now and you're in the right place.
0:01:33 > 0:01:34Yeah.
0:01:48 > 0:01:52At Saint Ann's Hospital in North London, I was on Phoenix Wing.
0:01:52 > 0:01:55An inpatient ward for people with eating disorders.
0:01:55 > 0:01:56Hi, Rosie. How are you?
0:01:56 > 0:01:58I'm good.
0:01:58 > 0:01:59A dentist's assistant,
0:01:59 > 0:02:03Rosie had admitted herself for treatment three months earlier.
0:02:03 > 0:02:05What's it like being here?
0:02:05 > 0:02:07- BACKGROUND:- Prison!
0:02:07 > 0:02:08"Prison", someone said!
0:02:08 > 0:02:11Yeah, pretty much.
0:02:11 > 0:02:15- Prison. Kath...- Did you mean that? - Yes, she did.
0:02:15 > 0:02:17She did.
0:02:17 > 0:02:22Yeah, like, it's definitely military, like, very time-consuming.
0:02:22 > 0:02:24Yes, there's a routine.
0:02:24 > 0:02:27- It's a structure.- It's a strict schedule.
0:02:27 > 0:02:28That's your schedule, is it?
0:02:28 > 0:02:31- Yeah.- It starts around 8:30am.
0:02:31 > 0:02:37We had breakfast and then we had snack - is 10:10am till 10:25am.
0:02:37 > 0:02:40And then from half eight till half nine we have supervision period,
0:02:40 > 0:02:42which is taken in the lounge.
0:02:42 > 0:02:44Toilets are locked, as well.
0:02:44 > 0:02:45After mealtimes?
0:02:45 > 0:02:49During mealtimes and after for that half-an-hour period.
0:02:49 > 0:02:51Some of us are on one-to-ones,
0:02:51 > 0:02:55which means, after supervision, when you do go to the toilet,
0:02:55 > 0:02:59a member of staff will come in that toilet with you.
0:02:59 > 0:03:02Because they've got to make sure you're not just eating the meals
0:03:02 > 0:03:05- but keeping...- Them down. - Keeping them down.
0:03:05 > 0:03:08- Yeah.- And so with you it was more a case of, sort of,
0:03:08 > 0:03:10not eating food in the first place?
0:03:10 > 0:03:16Yeah, I got a thrill out of... Not eating, starving myself, yeah.
0:03:16 > 0:03:20Just skipping meals, just because I didn't think it was necessary.
0:03:20 > 0:03:23- Really? Did you say you got a thrill out of it?- Mm.
0:03:23 > 0:03:25Would you call it a thrill?
0:03:26 > 0:03:30Now, looking back on it, no, but at the time, yeah.
0:03:38 > 0:03:40I suppose I'm curious to know how long you've been ill.
0:03:40 > 0:03:42That's one question I have.
0:03:42 > 0:03:46- I would say the illness started in October of last year.- Uh-hm.
0:03:46 > 0:03:50It got to Christmas and I still was in denial how much I was losing,
0:03:50 > 0:03:53but everyone around me was like, "You're losing a lot now,
0:03:53 > 0:03:57"we can see it." And then February, just went crashing down.
0:03:57 > 0:03:59I lost all physical movement.
0:03:59 > 0:04:02I couldn't walk, I was crawling up the stairs,
0:04:02 > 0:04:06I was having to get my dad to carry me up the stairs.
0:04:06 > 0:04:09I lost eyesight, I lost my hearing.
0:04:10 > 0:04:12In late February, we're talking?
0:04:12 > 0:04:16- Yeah.- Due to malnutrition, basically.
0:04:16 > 0:04:19You can lose your eyesight and your hearing because of diet
0:04:19 > 0:04:22- and lack of food?- Yeah.
0:04:22 > 0:04:25If I didn't come in that day, I could have died.
0:04:25 > 0:04:27I was nearly at cardiac arrest.
0:04:27 > 0:04:30And you've been living here ever since.
0:04:30 > 0:04:33- Yeah.- As an inpatient, but going home at weekends.
0:04:33 > 0:04:37Yeah, I do do overnights and weekends at home.
0:04:37 > 0:04:40When I get weighed on the Monday and Thursday, I feel happy that I'm
0:04:40 > 0:04:42putting on, but it does scare me, like, I don't want to...
0:04:43 > 0:04:45If I'm being honest, I don't want to come out of here
0:04:45 > 0:04:47and then get to the point where I'm overweight.
0:04:47 > 0:04:50And obviously I've got a target to aim towards.
0:04:50 > 0:04:53So I never want to go over that because then I'll freak out.
0:04:59 > 0:05:01Hello.
0:05:03 > 0:05:06Every fortnight, doctors and therapists meet
0:05:06 > 0:05:09to discuss their patients' progress and monitor their weight.
0:05:11 > 0:05:13I was meeting Rosie's team.
0:05:14 > 0:05:17That's a graph of Rosie's weight, is it?
0:05:17 > 0:05:23- Yes.- Basically. And it's dropping precipitously until a certain point.
0:05:23 > 0:05:26And what does that point represent?
0:05:26 > 0:05:29I think the lowest weight on that weight chart is where we...
0:05:29 > 0:05:31At the point of admission.
0:05:31 > 0:05:33So, she was dropping weight at quite a rate
0:05:33 > 0:05:35when she was an outpatient.
0:05:35 > 0:05:39So you could see that there was a need for a change of approach?
0:05:40 > 0:05:43What is the line that's going off at a steeper angle...
0:05:43 > 0:05:45Steeper gradient?
0:05:45 > 0:05:48So, the bottom line is half a kilo weight gain a week,
0:05:48 > 0:05:51so generally if people are falling within the two lines,
0:05:51 > 0:05:54then the rate of weight gain is what we would expect.
0:05:54 > 0:05:56Right. And that's interesting, isn't it?
0:05:56 > 0:06:01Because she's hugging that lower benchmark amazingly closely,
0:06:01 > 0:06:05almost as though she's sort of deliberately doing the minimum
0:06:05 > 0:06:09- acceptable weight gain.- Even yesterday, after the session,
0:06:09 > 0:06:12she said to me, "Sometimes I still don't believe
0:06:12 > 0:06:14"that I've got this illness."
0:06:18 > 0:06:21Inpatient units like Phoenix Wing cater
0:06:21 > 0:06:24to the most serious cases of anorexia.
0:06:24 > 0:06:25What's your name?
0:06:25 > 0:06:28- Ifzana.- Louis.- Nice to meet you.
0:06:28 > 0:06:31The condition has been on the increase in the UK,
0:06:31 > 0:06:34amongst women and men, whether because of fashion images,
0:06:34 > 0:06:38social media or other more complex reasons.
0:06:38 > 0:06:42Have you done inpatient recovery of this sort before?
0:06:42 > 0:06:43Oh, yes. I'm a veteran.
0:06:43 > 0:06:45OK.
0:06:45 > 0:06:48Treatment revolves around a timetable of three meals
0:06:48 > 0:06:52and three snacks every day, all strictly supervised.
0:06:53 > 0:06:56I don't particularly want to eat this cake and ice cream
0:06:56 > 0:06:58but I know that I have to. It's part of my treatment.
0:07:00 > 0:07:03Patients also receive therapy and classes in shopping for
0:07:03 > 0:07:07and preparing food, to help them build a healthier relationship
0:07:07 > 0:07:08with eating.
0:07:08 > 0:07:11Are you aware that you need some fats in your diet?
0:07:12 > 0:07:15The aim is for patients to regain their weight
0:07:15 > 0:07:17and return to living in the outside world.
0:07:25 > 0:07:28At a clinic in West London, called Vincent Square,
0:07:28 > 0:07:31I was meeting a daytime patient called Jess.
0:07:31 > 0:07:34- How's it going?- Hiya.- We met very briefly before, didn't we?
0:07:34 > 0:07:36- Yeah.- Louis.
0:07:36 > 0:07:38- Jess.- Am I all right here?
0:07:38 > 0:07:40Yeah, of course.
0:07:40 > 0:07:43Jess had been in treatment for nine years.
0:07:43 > 0:07:45Joining us was her nurse, James Kelly.
0:07:45 > 0:07:47So how long have you been here?
0:07:47 > 0:07:50I've been here just over a year.
0:07:50 > 0:07:52A year last week, I had my anniversary.
0:07:52 > 0:07:54- How old are you?- I'm 27.
0:07:54 > 0:07:56- 27.- 28, next week.
0:07:56 > 0:07:58And when did you first get diagnosed?
0:07:58 > 0:08:00I was 19.
0:08:00 > 0:08:02OK.
0:08:10 > 0:08:14Jess, is it the last six birthdays you've spent in hospital?
0:08:14 > 0:08:16- Yeah, last five.- Last five.- Yeah.
0:08:17 > 0:08:23And this kind of pattern of kind of going round again has been your life
0:08:23 > 0:08:24for the last five, six years.
0:08:25 > 0:08:28What's your sense of how Jess is doing?
0:08:28 > 0:08:33Things are slipping and deteriorating kind of physically.
0:08:33 > 0:08:37- Jess is struggling.- And how do you define that?
0:08:37 > 0:08:40Less food and more walking.
0:08:40 > 0:08:41You've been doing more walking.
0:08:43 > 0:08:47Yeah, I do quite a lot of walking and other exercise, as well.
0:08:49 > 0:08:51I really struggle with exercise.
0:08:51 > 0:08:53It's amazing. I'm still quite new to this.
0:08:53 > 0:08:56The idea of struggling with exercise to me still means
0:08:56 > 0:08:58that you need to do more!
0:08:58 > 0:09:01But you actually mean that you need to do less?
0:09:01 > 0:09:06Yeah, I mean, I do star jumps, as well, which is a bit of an issue.
0:09:06 > 0:09:09I've been doing them for years and years and never been able to break
0:09:09 > 0:09:14- the habit.- How many star jumps do you do? Here?
0:09:15 > 0:09:18Well, at the moment, I do, like, 2,000 day.
0:09:20 > 0:09:21I feel really ashamed.
0:09:21 > 0:09:23It's made you feel ashamed, talking about that?
0:09:23 > 0:09:25Yeah, and... Quite...
0:09:25 > 0:09:27I don't know.
0:09:27 > 0:09:30It's quite hard to admit it and to let people know about it.
0:09:31 > 0:09:34Feels like a bit of a shameful secret that I have to hide.
0:09:34 > 0:09:38But in your case it seems to me that they are a symptom of your illness.
0:09:39 > 0:09:42Again, to which no shame should be attached.
0:09:42 > 0:09:45- That's an illness.- Yeah.
0:09:52 > 0:09:56Jess came from a family of successful lawyers.
0:09:56 > 0:09:58She dreamed of becoming a teacher.
0:09:59 > 0:10:01Although she'd graduated from university,
0:10:01 > 0:10:04she'd never had a full-time job, due to her illness.
0:10:04 > 0:10:08That's my sister's graduation, when I was nearly a healthy weight.
0:10:08 > 0:10:10- Which one are you?- This one.- Wow.
0:10:18 > 0:10:19- Is that you?- Yeah.
0:10:22 > 0:10:25- Same time?- No, that was when I was about 17.
0:10:25 > 0:10:27- Can I keep going?- Yeah, I guess.
0:10:27 > 0:10:29Not going to find anything weird.
0:10:29 > 0:10:31No, it's not going to be weird.
0:10:31 > 0:10:32That's a joke.
0:10:34 > 0:10:37A lot of people kind of say things to me, like,
0:10:37 > 0:10:39you used to be so pretty, or you'd be so beautiful
0:10:39 > 0:10:42if you gained some weight, and that's just missing the point
0:10:42 > 0:10:46entirely because I'm under no illusion that I'm attractive
0:10:46 > 0:10:50as I am now or that I would be any more attractive if I lost weight,
0:10:50 > 0:10:52but I still want to lose weight.
0:10:52 > 0:10:54It's not about being attractive.
0:11:01 > 0:11:03What do you think the misconceptions are?
0:11:05 > 0:11:08I guess that it's, perhaps, a self...
0:11:09 > 0:11:14An attention-seeking thing and that it's all because the media portrays
0:11:14 > 0:11:17this image that the ideal size is a size zero and all that stuff
0:11:17 > 0:11:20and it's not about that at all, like...
0:11:22 > 0:11:23People just don't get it.
0:11:24 > 0:11:27If you accept it's not about a size zero,
0:11:27 > 0:11:29although probably those images aren't helpful...
0:11:29 > 0:11:32- Yeah.- Do you have any sense of where it does come from?
0:11:34 > 0:11:36I think it's a mixture of things.
0:11:36 > 0:11:38It's partly a self-punishment thing,
0:11:38 > 0:11:40thinking that I don't deserve to eat,
0:11:40 > 0:11:45I don't deserve nice things, I don't deserve to enjoy myself and...
0:11:45 > 0:11:49..I restrict food and exercise as a punishment to myself.
0:11:49 > 0:11:50But then, conversely,
0:11:50 > 0:11:53it's also a control thing and an anxiety thing that at times
0:11:53 > 0:11:55it actually makes me feel better.
0:11:57 > 0:12:00I guess what I'm curious about is what sort of emotions
0:12:00 > 0:12:03or what feelings you would get from eating, for example.
0:12:03 > 0:12:08I feel so guilty and disgusting.
0:12:08 > 0:12:12I just want to, like, physically tear the skin off me
0:12:12 > 0:12:16and the fat off me and just... It's just awful.
0:12:16 > 0:12:17In my head, I shouldn't like food,
0:12:17 > 0:12:20it's disgusting and greedy and horrible to like food
0:12:20 > 0:12:25and that makes me a fat, greedy pig and I shouldn't let the world know
0:12:25 > 0:12:28that, actually, I do like the taste of some foods!
0:12:33 > 0:12:34As at Phoenix Ward,
0:12:34 > 0:12:38patients at Vincent Square spend most of their time eating meals
0:12:38 > 0:12:40and attending therapeutic groups.
0:12:41 > 0:12:44The average stay is around four months,
0:12:44 > 0:12:48but it's not uncommon for inpatients to stay a year or longer,
0:12:48 > 0:12:50and many return.
0:12:51 > 0:12:55The clinical director is Dr Frances Connan.
0:12:55 > 0:12:58Anorexia is a mental illness, that's correct, isn't it?
0:12:58 > 0:13:01Yeah. And one of the things we always say about anorexia
0:13:01 > 0:13:04as a mark of its seriousness, is it has the highest mortality
0:13:04 > 0:13:06of any psychiatric disorder.
0:13:06 > 0:13:07And that's staggering.
0:13:07 > 0:13:10Do we know what causes it?
0:13:10 > 0:13:12None of us can really say we know what the cause
0:13:12 > 0:13:14of anorexia nervosa is.
0:13:14 > 0:13:17There are biological factors as well as psychological factors that
0:13:17 > 0:13:21contribute. So it's things like personality type.
0:13:21 > 0:13:25People who have more obsessive-compulsive type
0:13:25 > 0:13:30personality traits, perfectionism, and those interact
0:13:30 > 0:13:33with life experience to come together to cause the expression
0:13:33 > 0:13:35of the illness.
0:13:35 > 0:13:37So how do you help...
0:13:37 > 0:13:40How do you treat the people that you see here?
0:13:40 > 0:13:44So, one of the ways we can help you get better and stay well is to help
0:13:44 > 0:13:50build resilience in emotional coping and interpersonal coping, so that you
0:13:50 > 0:13:54don't have to rely on not eating as a way of coping with the world
0:13:54 > 0:13:55and as a response to stress.
0:14:04 > 0:14:07People with anorexia tend to experience their first symptoms
0:14:07 > 0:14:10in their late teens and early 20s.
0:14:10 > 0:14:14Many go on to wrestle with the illness throughout their lives.
0:14:14 > 0:14:17I was meeting 63-year-old Janet.
0:14:17 > 0:14:20- Hi, Janet.- Hi, Louis, how are you? - Louis.- Thank you for coming.
0:14:20 > 0:14:21Thank you, thank you for having me.
0:14:21 > 0:14:22You're welcome.
0:14:22 > 0:14:24- Come in.- Show me the way.
0:14:24 > 0:14:25OK. All right.
0:14:27 > 0:14:28Mind the step.
0:14:32 > 0:14:34I've just had my breakfast.
0:14:34 > 0:14:37- Did you?- Yes, which took, like, two seconds.
0:14:37 > 0:14:43- What did you have?- I had that much of bread and a tiny bit of cheese.
0:14:43 > 0:14:44But now I feel like I have to walk it off.
0:14:44 > 0:14:48- Why?- Because I can't bear the calories inside me.
0:14:50 > 0:14:54Janet first experienced symptoms aged 18.
0:14:54 > 0:14:59She was diagnosed at 33 and has spent most of her life since as an
0:14:59 > 0:15:02outpatient at Vincent Square, while living at home
0:15:02 > 0:15:05and working at a job centre.
0:15:05 > 0:15:08These are crackers. I cannot eat a whole cracker.
0:15:08 > 0:15:12If I eat a whole cracker, the guilt is horrendous.
0:15:12 > 0:15:17I can't do it. So what I do, I shake it up...
0:15:18 > 0:15:20Shake it up, right?
0:15:20 > 0:15:22And then I just take a little bit.
0:15:22 > 0:15:24So that I would have for lunch.
0:15:24 > 0:15:26- That's my lunch.- Are you serious?
0:15:26 > 0:15:27Yeah, I'm being serious.
0:15:27 > 0:15:29Would I joke about something like this?
0:15:29 > 0:15:32I have to go for a walk, an hour's walk after I've eaten this.
0:15:32 > 0:15:35Or for a change, I might have that.
0:15:35 > 0:15:38I don't want to get bored with the same thing.
0:15:38 > 0:15:39Yeah? Or one of these.
0:15:41 > 0:15:43But that, I would have to break in half because I couldn't cope with
0:15:43 > 0:15:45- eating the whole one.- You said you loved the biscuit
0:15:45 > 0:15:48- but you don't enjoy eating it. - Because of the guilt.
0:15:48 > 0:15:49But you love eating it?
0:15:49 > 0:15:51There's two sides to me.
0:15:51 > 0:15:53There's one that's anorexic, and one that isn't.
0:15:53 > 0:15:57One that's trying to get better, and one that is the anorexic.
0:15:57 > 0:16:00And one is saying, you shouldn't be doing this.
0:16:00 > 0:16:03And the anorexic is saying, but this is all I've ever known.
0:16:03 > 0:16:05I'm your best friend.
0:16:05 > 0:16:08- Which side is bigger?- The anorexic.
0:16:08 > 0:16:09How much bigger?
0:16:10 > 0:16:13A lot bigger. 99%.
0:16:15 > 0:16:16Are those chocolates?
0:16:16 > 0:16:19Yeah. I'm allowed one a month.
0:16:19 > 0:16:21The first of every month I get so excited because I'm allowed
0:16:21 > 0:16:24a little bit of ice cream and one chocolate.
0:16:24 > 0:16:25Do you want one?
0:16:26 > 0:16:28- Are you going to have one?- No.
0:16:29 > 0:16:31No, because it's not the 1st of July yet.
0:16:31 > 0:16:33- Where did that rule come from? - I don't know.
0:16:33 > 0:16:36But that's what I let myself have, one a month.
0:16:36 > 0:16:38My sweets. I can't eat a whole one.
0:16:38 > 0:16:41I have to boil it down, and I'll suck it again a bit later.
0:16:41 > 0:16:43That will last me a week.
0:16:43 > 0:16:46- Really?- That's four weeks' worth of sweets there.
0:16:46 > 0:16:48Hard sweets.
0:16:48 > 0:16:51- Really?- Why have you got several on the go at once?
0:16:51 > 0:16:53Because then psychologically I don't feel like I'm eating too many.
0:16:57 > 0:16:58They call me nuts!
0:16:58 > 0:17:00LAUGHTER
0:17:06 > 0:17:08Look at my hands.
0:17:09 > 0:17:10What's happened to your nails?
0:17:10 > 0:17:14Because I'm not eating, the circulation is not working now.
0:17:14 > 0:17:18- My body's packing up.- That's why they're red like that, reddy-purple?
0:17:18 > 0:17:19Purple.
0:17:23 > 0:17:24- They're quite cold.- Mm.
0:17:27 > 0:17:29It's a nightmare, this is a nightmare.
0:17:29 > 0:17:31I've had it since I was 18. I'm 63.
0:17:31 > 0:17:34But there's something stopping you from eating.
0:17:34 > 0:17:36What is it?
0:17:38 > 0:17:45I feel if I eat then I've lost control and if I eat...
0:17:45 > 0:17:49When you're starving, it gets so bad that you feel pain.
0:17:49 > 0:17:50It numbs everything.
0:17:50 > 0:17:53It numbs your thinking, you can't think straight.
0:17:53 > 0:17:56If something happens, like when my mum died and my sister died,
0:17:58 > 0:18:02I didn't feel the pain, because I was numb - I was so hungry.
0:18:02 > 0:18:04You want to be well.
0:18:04 > 0:18:06- I do.- I'm getting very mixed messages.
0:18:07 > 0:18:08It's not an easy one.
0:18:08 > 0:18:10It's really confusing.
0:18:12 > 0:18:14I don't feel I deserve...
0:18:15 > 0:18:17I don't feel I deserve...
0:18:17 > 0:18:20I don't feel I deserve.
0:18:20 > 0:18:23Is that what it is? Unworthiness?
0:18:23 > 0:18:26I'll eat off the floor, I'll eat out my bin.
0:18:28 > 0:18:31But if somebody buys me something, I'll throw it away.
0:18:33 > 0:18:37I don't feel I deserve nice clothes.
0:18:37 > 0:18:40When my sister died, I thought it should have been me.
0:18:44 > 0:18:45It was striking that Janet,
0:18:45 > 0:18:49with 40 years of experience with the illness and insight into its
0:18:49 > 0:18:51workings, was still struggling.
0:18:57 > 0:18:59- Do you want to do it?- Yeah, let's go.- You lead the way.
0:19:01 > 0:19:03Less than a year into her anorexia,
0:19:03 > 0:19:06Rosie was still coming to terms with the illness.
0:19:08 > 0:19:12It was the weekend. Rosie's dad, Paul, was picking her up
0:19:12 > 0:19:14for her home leave.
0:19:14 > 0:19:16- Paul. Louis.- Nice to meet you, Louis.- How's it going?
0:19:16 > 0:19:18- All right, thank you. - Nice to meet you.- And you.
0:19:21 > 0:19:25The life-changing nature of anorexia means that it puts huge strains
0:19:25 > 0:19:27on families.
0:19:27 > 0:19:30I was curious to hear the perspective of her parents.
0:19:32 > 0:19:34- Hi, Heather, Louis. - Hi, Louis, all right?
0:19:34 > 0:19:36- Yeah, how are you doing? - I'm fine, you?
0:19:36 > 0:19:39- Nice to meet you.- And you.- Thanks for having us.- That's all right.
0:19:49 > 0:19:51- Go on, then.- No, oh, God, no.
0:19:53 > 0:19:56- Glasses.- Yeah, I do wear glasses.
0:19:56 > 0:19:57That's a nice look, I think.
0:19:57 > 0:19:59It is not!
0:20:01 > 0:20:03You were going to show me that one up there.
0:20:03 > 0:20:05That's my one of last year.
0:20:05 > 0:20:07I was going out on a night out.
0:20:09 > 0:20:12And, yeah, that's usually on a typical night out.
0:20:12 > 0:20:14- What I do is...- Take about 30 pictures.
0:20:14 > 0:20:15Take about 30 pictures.
0:20:15 > 0:20:16And put them on Instagram?
0:20:16 > 0:20:21- Or just choose the best one? - Choose the best one, yeah.
0:20:21 > 0:20:23So, there was nothing in the background,
0:20:23 > 0:20:26no inkling that you might have this illness in your future.
0:20:26 > 0:20:28Nothing at all.
0:20:28 > 0:20:30If I thought I would be here in a year's...
0:20:30 > 0:20:32Like, a year before, I would have just laughed at you.
0:20:32 > 0:20:33- But you nearly died, in fact.- Mm.
0:20:34 > 0:20:36Yeah.
0:20:37 > 0:20:39- You were working...- I kind of wanted to.
0:20:39 > 0:20:41You wanted to die?
0:20:41 > 0:20:42- Why?- Because I gave up.
0:20:44 > 0:20:46I gave up, I couldn't do it any more.
0:20:46 > 0:20:48Kept telling my mum and dad I wanted myself dead.
0:20:56 > 0:20:58- You all right?- Yeah.
0:20:58 > 0:21:00Fine. Yeah, coping.
0:21:00 > 0:21:01- Coping.- Must be difficult.
0:21:03 > 0:21:04We just take day by day.
0:21:05 > 0:21:10Day by day now. We couldn't have coped no longer at home.
0:21:10 > 0:21:11Couldn't have done no longer.
0:21:11 > 0:21:13It must have been shattering to go through.
0:21:13 > 0:21:15It was... God...
0:21:17 > 0:21:21You couldn't sleep at night, thinking, thinking, thinking,
0:21:21 > 0:21:22thinking all the time.
0:21:22 > 0:21:25You know, what do we do?
0:21:25 > 0:21:26What do we do? Where do we take her?
0:21:26 > 0:21:28Terrible, terrible times.
0:21:30 > 0:21:32It's like a living, living, living hell.
0:21:37 > 0:21:42It all started when I feel like I got rejected by someone
0:21:42 > 0:21:46and I just felt like I had to change, but then,
0:21:46 > 0:21:48now I think back, why did I?
0:21:48 > 0:21:50Why did I change?
0:21:50 > 0:21:53You must have known something was up.
0:21:53 > 0:21:56I did, but I was just hoping and praying,
0:21:56 > 0:21:58please stop going to the gym.
0:21:58 > 0:22:01I thought once she'd stopped the gym,
0:22:01 > 0:22:05perhaps it might have gotten back.
0:22:05 > 0:22:06This might have all just stopped.
0:22:06 > 0:22:07I thought it was just a phase.
0:22:07 > 0:22:11And the trouble is, you're just trying to keep her happy because,
0:22:11 > 0:22:14at the end of the day, that's what she wanted to do
0:22:14 > 0:22:15and I was frightened if I...
0:22:15 > 0:22:17- They were scared of me.- Why?
0:22:17 > 0:22:19- They were scared of me. - A lot of anger.
0:22:19 > 0:22:21A lot of anger.
0:22:21 > 0:22:24Not scared, in a way... But I was frightened that she...
0:22:24 > 0:22:27- No, you were, you were scared.- She much turn around and go, well,
0:22:27 > 0:22:30if you don't do this for me, then I'm just going to leave
0:22:30 > 0:22:33- and what have you.- I'm going to harm myself or do something...
0:22:33 > 0:22:36- Silly.- You sound very confident saying they were scared of you.
0:22:36 > 0:22:38- Based on...?- Yeah.
0:22:38 > 0:22:41I know they were scared. They were scared to say no.
0:22:41 > 0:22:45- Why?- Because they know that if I didn't get what I wanted...
0:22:46 > 0:22:49..then I would just lose my temper.
0:22:49 > 0:22:51I knew how to push their buttons.
0:22:51 > 0:22:54- It give you a lot of power, I suppose.- Mm.
0:22:57 > 0:23:00It doesn't matter how much we argue,
0:23:00 > 0:23:04you can't go through life going to me, bye, I've blocked you,
0:23:04 > 0:23:05I've done this, I've done that.
0:23:05 > 0:23:07But then again, that's her...
0:23:07 > 0:23:09But I just feel like you're not proud of me.
0:23:09 > 0:23:11When I do gain weight, you never go, "Oh, well done."
0:23:11 > 0:23:14- I do, babe.- But then when I'm going down in weight,
0:23:14 > 0:23:16you just assume it's always me, that it's always my fault.
0:23:16 > 0:23:18Yeah, it's my fault but I've tried.
0:23:18 > 0:23:21You need to say, "Well done, you've tried."
0:23:21 > 0:23:24You can't go, "Oh, well, you've not eaten enough."
0:23:24 > 0:23:26You're not there to support me, really,
0:23:26 > 0:23:28so that's what their problem is now at the unit,
0:23:28 > 0:23:31that you're not supporting me enough in terms of meals.
0:23:35 > 0:23:37Whilst on home leave,
0:23:37 > 0:23:40Rosie was expected to stick to the hospital's meal plan,
0:23:40 > 0:23:43to ensure she continued to gain weight.
0:23:51 > 0:23:55The sense I get is, it's quite easy to say the wrong thing.
0:23:57 > 0:23:58Yeah, it is. Yeah.
0:24:00 > 0:24:01Every day's...
0:24:02 > 0:24:04You tread on eggshells.
0:24:04 > 0:24:08And then you tiptoe around and then she's aware of that and that makes
0:24:08 > 0:24:12- it worse.- Yes.- She feels infantilised, it's like you're being too careful.
0:24:12 > 0:24:17Yeah, yeah. Every single time you open your mouth,
0:24:17 > 0:24:20you just don't know what reaction you're going to get from her.
0:24:21 > 0:24:22Nice?
0:24:27 > 0:24:29That's a mixture, Rose?
0:24:35 > 0:24:38I still look at her and I still don't think she's right.
0:24:38 > 0:24:42- In what way?- She's still looking at her phone, plates of food.
0:24:42 > 0:24:44What do you mean, looking at her phone?
0:24:44 > 0:24:50She seems to get the phone and just, all different meals,
0:24:50 > 0:24:54she just sits there looking at them, scrolling through them all the time.
0:24:55 > 0:24:56We don't say anything as we walk past her,
0:24:56 > 0:24:59but we can see what she's doing, like a habit.
0:25:03 > 0:25:05How do you feel, having just had a snack?
0:25:05 > 0:25:06- Do you feel all right?- Yeah.
0:25:06 > 0:25:09You seem more relaxed, suddenly.
0:25:09 > 0:25:10- Yeah.- Right now.
0:25:10 > 0:25:11What's that about?
0:25:12 > 0:25:14Because...
0:25:14 > 0:25:17I think I know I've had it and I've had it at the right time and
0:25:17 > 0:25:20- everything like that.- Where you getting tense before
0:25:20 > 0:25:21because of the snack?
0:25:21 > 0:25:24I worry mainly for my measurements that it's the right...
0:25:24 > 0:25:27- That it's enough.- Are you worried about having too much or too little?
0:25:27 > 0:25:29Too little.
0:25:31 > 0:25:36Given that, basically, the idea is for you to put weight on,
0:25:36 > 0:25:39you could have extra and it certainly wouldn't
0:25:39 > 0:25:41get you into trouble, but there's something in you
0:25:41 > 0:25:43- that's stopping that.- Yeah.
0:25:45 > 0:25:48Rosie's anorexia had afflicted the entire family.
0:25:50 > 0:25:53Even with Rosie seemingly doing well in recovery,
0:25:53 > 0:25:56the illness and its demands were still a daily struggle
0:25:56 > 0:25:58for all of them.
0:26:03 > 0:26:07One of the most striking features of anorexia is the difficulty many
0:26:07 > 0:26:10patients have in seeing themselves as ill.
0:26:10 > 0:26:13I feel that people are judging me by
0:26:13 > 0:26:15my body and looking at me and thinking,
0:26:15 > 0:26:17"Oh, what is she doing here?
0:26:17 > 0:26:20"She's too fat to be here.
0:26:20 > 0:26:21"Why? What the hell is she doing here?"
0:26:23 > 0:26:26Many of those in inpatient treatment are there against their will.
0:26:28 > 0:26:30Among them, was Ifzana.
0:26:30 > 0:26:31- Hiya.- Hello.
0:26:31 > 0:26:32Hi, Rosie. How are you?
0:26:32 > 0:26:34Nice to see you. Hi, Ifzana, how are you?
0:26:34 > 0:26:37I'm OK, thank you.
0:26:37 > 0:26:39You've done my bloods before, you usually get it in one.
0:26:39 > 0:26:42- You're really good at it.- Now you're going to give it bad luck, though.
0:26:42 > 0:26:44No pressure!
0:26:44 > 0:26:46That looks good.
0:26:46 > 0:26:48She's really good at taking blood.
0:26:50 > 0:26:52An assistant in an operating theatre,
0:26:52 > 0:26:55Ifzana had been brought into Phoenix Wing two weeks earlier,
0:26:55 > 0:26:58after being sectioned.
0:26:58 > 0:27:01It was her third round of residential treatment.
0:27:01 > 0:27:06When did people start noticing that you had an issue around food?
0:27:06 > 0:27:09I've had it probably about five years.
0:27:09 > 0:27:12I was at a much, much lower weight.
0:27:12 > 0:27:16My ECG, yeah, it kind of basically looked similar to someone
0:27:16 > 0:27:18who'd had a heart attack.
0:27:21 > 0:27:23It sounded like you nearly died.
0:27:23 > 0:27:27Yeah. Even now when they say that, part of me's a bit like,
0:27:27 > 0:27:30"Oh, you guys are just being melodramatic," but...
0:27:30 > 0:27:33I don't want to dwell on it too much because they're going to obviously stick to
0:27:33 > 0:27:36their opinion, I'm going to stick to my mine.
0:27:36 > 0:27:37We're not going to move any way.
0:27:40 > 0:27:44- You wanted to leave.- Yes.- Even when you were in hospital, nearly dying?
0:27:46 > 0:27:48Does that seem odd to you?
0:27:48 > 0:27:51I guess because I couldn't physically feel it...
0:27:51 > 0:27:52Could you see it in the mirror?
0:27:52 > 0:27:55- No.- You thought you looked fine?
0:27:55 > 0:27:56Yeah.
0:27:59 > 0:28:03Do you accept that you have anorexia?
0:28:03 > 0:28:08I guess. Obviously, if I had to go into an inpatient hospital
0:28:08 > 0:28:12for nine months in Cambridge and then come out and then go back
0:28:12 > 0:28:16into hospital, then there was obviously a reason for it.
0:28:18 > 0:28:20You were sectioned to come here.
0:28:20 > 0:28:23- Uh-hm.- If you hadn't been, would you be here?- No.
0:28:27 > 0:28:30- OK, thank you very much. - You're welcome.- Thanks.
0:28:32 > 0:28:33Wish me luck.
0:28:37 > 0:28:39How old are you?
0:28:39 > 0:28:41I like when people guess.
0:28:43 > 0:28:44Well, sometimes I do.
0:28:50 > 0:28:51Don't think so hard.
0:28:52 > 0:28:54You're 23.
0:28:54 > 0:28:57How the hell do you know? You probably saw my notes beforehand
0:28:57 > 0:28:59- or something.- No. Are you 23?
0:28:59 > 0:29:00I'll be 24 in July.
0:29:01 > 0:29:03God, I feel old.
0:29:08 > 0:29:10Hi, sorry to keep you waiting.
0:29:10 > 0:29:12- No problem.- Do you want to come in? - Yes.
0:29:12 > 0:29:16I was joining Ifzana for her fortnightly review.
0:29:16 > 0:29:19She had requested leave from the ward.
0:29:19 > 0:29:23I was hoping this weekend, either get Saturday and Sunday,
0:29:23 > 0:29:27one to three on both days or on one day, one to five.
0:29:27 > 0:29:29In terms of the leave, then,
0:29:29 > 0:29:31I think what you need to do is go out in the wheelchair.
0:29:31 > 0:29:33Oh, no, we're not going back to that.
0:29:33 > 0:29:37- Yeah.- No.- I think, Ifzana, just because we want to minimise
0:29:37 > 0:29:40the activity level and because of the low blood pressure.
0:29:40 > 0:29:41We're going to be looking...
0:29:41 > 0:29:43But that's what I'm saying, to do my blood pressure beforehand.
0:29:43 > 0:29:46OK, if it's low, then I'll go out in the wheelchair,
0:29:46 > 0:29:48but I don't want to be told, yeah, you're going out in the wheelchair,
0:29:48 > 0:29:51because if it isn't low, then I feel like...
0:29:51 > 0:29:54Is it to minimise activity and therefore not too many calories
0:29:54 > 0:29:57- are getting burned? - That's right, yes.
0:29:57 > 0:30:01It's not that you think Ifzana necessarily is going to keel over.
0:30:01 > 0:30:05No, it's partly because of the low blood pressure but I think that's
0:30:05 > 0:30:10getting better. But partly it is because of activity levels.
0:30:10 > 0:30:13What we want to do is we want to limit that as much as possible
0:30:13 > 0:30:15- so that is...- Yes, but yesterday I went for my leave,
0:30:15 > 0:30:19and I went without the wheelchair and my weight still went up
0:30:19 > 0:30:21so I think...
0:30:21 > 0:30:23I've been here before, so I think there should be a level of trust.
0:30:23 > 0:30:26What we could also do is have a look at sort of how the blood pressure
0:30:26 > 0:30:28goes sort of today,
0:30:28 > 0:30:30tomorrow and Wednesday in terms of how things are looking.
0:30:30 > 0:30:32OK, fine. And we'll do that, as well.
0:30:37 > 0:30:41Ifzana had also been attempting to burn calories by standing.
0:30:42 > 0:30:44Would you like to take a seat?
0:30:44 > 0:30:48- Not really.- They did say you should sit down more.
0:30:48 > 0:30:49Yeah, they say a lot of things.
0:30:49 > 0:30:51You don't want to sit down?
0:30:51 > 0:30:53- No.- Do you want to try?
0:30:53 > 0:30:55I can sit down.
0:30:55 > 0:30:56Let's see what happens.
0:30:56 > 0:30:58Nothing's going to happen.
0:30:58 > 0:30:59I sat down at snack.
0:30:59 > 0:31:01Do it now and see how it feels.
0:31:01 > 0:31:02- No.- Just for a second.
0:31:03 > 0:31:04Here.
0:31:08 > 0:31:10- Stay sitting down. - You said a second!
0:31:11 > 0:31:12Now for ten seconds.
0:31:17 > 0:31:20How does that feel now?
0:31:20 > 0:31:23I know, short term, it doesn't really feel like anything.
0:31:23 > 0:31:25It kind of feels like an inconvenience, to be honest.
0:31:28 > 0:31:30What are you doing? You look uncomfortable.
0:31:30 > 0:31:31I'm just trying to...
0:31:31 > 0:31:32HE CLEARS THROAT
0:31:32 > 0:31:35- Do you want to sit down again?- No.
0:31:35 > 0:31:38I'm not an animal or a...
0:31:38 > 0:31:39I have to jump through their hoops,
0:31:39 > 0:31:42I'm not going to jump through yours, as well!
0:31:52 > 0:31:54I have the impression she's not really sure
0:31:54 > 0:31:56whether she really has the illness.
0:31:56 > 0:32:00I mean, that's not sort of uncommon with a lot of our patients,
0:32:00 > 0:32:04in that they... On some level, they can see that they're unwell,
0:32:04 > 0:32:06but on other levels it's quite difficult for them to.
0:32:06 > 0:32:09Or even if, maybe, she accepts she has got the illness,
0:32:09 > 0:32:13but perhaps she'd just...like to have the illness.
0:32:13 > 0:32:15We'd always encourage people to go for recovery,
0:32:15 > 0:32:18but if it's too difficult, what we say is, right, OK,
0:32:18 > 0:32:19let's go somewhere in between.
0:32:19 > 0:32:22You don't give up the eating disorder because you need it for whatever reason.
0:32:22 > 0:32:26It's a way of managing something and so we help you just manage things in
0:32:26 > 0:32:29the community, so you can actually have some sort of quality of life.
0:32:29 > 0:32:33So, with Ifzana, strictly speaking, you're not aiming
0:32:33 > 0:32:36- for a full recovery.- No.
0:32:36 > 0:32:39That's because Ifzana doesn't want that at the moment.
0:32:39 > 0:32:42If you did nothing at all, if there was no treatment whatsoever,
0:32:42 > 0:32:43what would happen?
0:32:43 > 0:32:47I think there'd be a very high risk of death, essentially.
0:32:51 > 0:32:55I began to settle into the routine of life in the clinics.
0:32:55 > 0:32:58We've got cottage pie or we've got vegetarian cottage pie.
0:32:58 > 0:33:00I'll try the veg, the vegetarian.
0:33:02 > 0:33:05It was baffling to find people seemingly so insightful
0:33:05 > 0:33:08and full of promise who were, at the same time,
0:33:08 > 0:33:11in the grip of something so irrational.
0:33:11 > 0:33:13- How are you doing?- Yeah, not bad.
0:33:13 > 0:33:15Especially when it's hot, but there you go.
0:33:17 > 0:33:20Making it all the more strange was the way patients valued
0:33:20 > 0:33:24and held on to symptoms that could end up killing them.
0:33:24 > 0:33:29While recovery was nearly always viewed with ambivalence and fear.
0:33:29 > 0:33:31I've never cooked in my life.
0:33:31 > 0:33:32You're cooking right now.
0:33:34 > 0:33:37Despite the support of clinical staff and families,
0:33:37 > 0:33:41it was hard to see how patients would ever break the cycle.
0:33:41 > 0:33:44Once I leave hospital, give me long enough and eventually things will
0:33:44 > 0:33:46start going backwards.
0:33:49 > 0:33:52At Phoenix Wing, change was in the air.
0:33:52 > 0:33:55Rosie had let me know she would be making an announcement
0:33:55 > 0:33:56in her fortnightly review.
0:33:58 > 0:34:01- Hello.- Buongiorno! How's it going?
0:34:01 > 0:34:03- Very well. Yourself? - Good to see you.
0:34:03 > 0:34:05- You, too.- Light hug?
0:34:05 > 0:34:06Very light, distant?
0:34:06 > 0:34:08- There we go.- There you go.
0:34:08 > 0:34:10Feel like it's been a while.
0:34:10 > 0:34:12Yeah. How you doing?
0:34:12 > 0:34:15OK. I've been waiting for this all day, so, yeah...
0:34:15 > 0:34:19- Have you?- Yeah.- Do you like your ward rounds?
0:34:19 > 0:34:21When I get a good outcome, yeah.
0:34:21 > 0:34:23If I don't, then you'll see.
0:34:23 > 0:34:29- Do you know what they're going to say?- Erm, not really.
0:34:29 > 0:34:30A bit anxious.
0:34:30 > 0:34:33And you've submitted in writing...
0:34:33 > 0:34:37- Yeah.- ..a rough sense of what's on your agenda.
0:34:37 > 0:34:41Yeah. Yeah. So I'm just worried about the outcome.
0:34:41 > 0:34:43Hope it's all positive, I really do.
0:34:43 > 0:34:45- What's on your agenda? - That'd be telling, wouldn't it?
0:34:45 > 0:34:47You'll have to wait and see.
0:34:48 > 0:34:50- Oh, I like it.- Yeah.
0:34:50 > 0:34:52I love surprises.
0:34:52 > 0:34:53Yeah.
0:34:53 > 0:34:54Hello.
0:34:58 > 0:35:01Right, so, yeah, so your ward round...
0:35:01 > 0:35:05- So let's go through the points.- What I wanted to discuss with you...
0:35:06 > 0:35:11..is immediate discharge into a well-equipped environment
0:35:11 > 0:35:15and a supportive family and work with the outpatient services
0:35:15 > 0:35:19and also continue my family therapy, as I find it very proactive
0:35:19 > 0:35:23and helpful. Sorry...
0:35:28 > 0:35:29I do worry about immediate discharge,
0:35:29 > 0:35:31if I'm completely honest with you.
0:35:31 > 0:35:33You are informal.
0:35:33 > 0:35:36This is... I would say, if we discharge you today,
0:35:36 > 0:35:38it's against medical advice.
0:35:40 > 0:35:44Rosie had decided she was done with inpatient treatment,
0:35:44 > 0:35:46but the clinical staff were concerned
0:35:46 > 0:35:48that as someone still relatively new to the illness,
0:35:48 > 0:35:51she was more unwell than she realised.
0:35:52 > 0:35:55You've just decided you've had enough, haven't you?
0:35:55 > 0:35:59I have. I just don't belong here any more.
0:35:59 > 0:36:02Maybe you don't think you really have an eating disorder.
0:36:02 > 0:36:04I feel like I've overcome it.
0:36:06 > 0:36:08That could be the anorexia telling you that.
0:36:09 > 0:36:14I think at this stage it isn't, it's me.
0:36:21 > 0:36:25The following morning, it emerged that staff had decided not to grant
0:36:25 > 0:36:29Rosie's discharge, but instead give her an extended leave.
0:36:45 > 0:36:46I know.
0:36:46 > 0:36:48Shhhh.
0:36:50 > 0:36:52ROSIE SOBS
0:36:52 > 0:36:53Come on.
0:36:53 > 0:36:55Don't get upset.
0:36:59 > 0:37:04It did take us by surprise yesterday that Rosie wished to self-discharge,
0:37:04 > 0:37:08so what I have done is I've gone back to the notes
0:37:08 > 0:37:14and just to kind of follow her, kind of... How she coped with the leave.
0:37:14 > 0:37:18And since May, it felt that the home leave...
0:37:18 > 0:37:20She has consistently lost weight.
0:37:23 > 0:37:26Based on what I've seen here, I don't feel
0:37:26 > 0:37:28that you're ready for discharge.
0:37:30 > 0:37:34I couldn't help but empathise with Rosie, denied her freedom
0:37:34 > 0:37:39but also with the clinical team put in the position of making decisions
0:37:39 > 0:37:42in the interests of patients but against their will.
0:37:42 > 0:37:45Can I take that, the advice that we've given,
0:37:45 > 0:37:48this medical recommendation is something that you are in agreement
0:37:48 > 0:37:51- with at the moment?- I feel like I have no choice.
0:37:55 > 0:37:58It looks from the beginning of May that she has been
0:37:58 > 0:38:02consistently losing the weight and the weight that she has managed...
0:38:02 > 0:38:04- At home?- At home, yeah.
0:38:04 > 0:38:07It is very apparent that, you know, overnight leave is a problem
0:38:07 > 0:38:09and it doesn't feel that she has mastered it.
0:38:09 > 0:38:13She has managed shorter periods of leave but not the longer one.
0:38:13 > 0:38:14These big decisions,
0:38:14 > 0:38:17we have to think about them very, very carefully.
0:38:17 > 0:38:20And I feel there will be sufficient grounds to say that,
0:38:20 > 0:38:23if she did insist to leave,
0:38:23 > 0:38:27it can be that we will get a second opinion from a mental health...
0:38:27 > 0:38:29I haven't said that because Rosie did agree.
0:38:29 > 0:38:31- You mean a section?- Yeah.
0:38:31 > 0:38:34So basically if she's resisting - "I don't care what you think,
0:38:34 > 0:38:36"I'm still going home."
0:38:36 > 0:38:39You would seriously consider getting a section?
0:38:39 > 0:38:41- Yeah.- Initiating the process.
0:38:41 > 0:38:44- Yeah, yeah.- Yeah. Big decision.
0:38:44 > 0:38:49I suspect whether there is a fear of continuing recovery,
0:38:49 > 0:38:52whether there's a realisation that it's not as easy
0:38:52 > 0:38:53as I thought it would be.
0:38:54 > 0:38:58Rosie's apparent confidence that she was well again, spoke to what
0:38:58 > 0:39:02may be anorexia's most insidious characteristic.
0:39:02 > 0:39:05How it hijacks patients' thinking,
0:39:05 > 0:39:08tricking them into allowing it control of their lives
0:39:08 > 0:39:11and their decisions and making recovery elusive.
0:39:19 > 0:39:20Thank you.
0:39:21 > 0:39:25At Vincent Square, I discovered Jess was in difficulties.
0:39:25 > 0:39:28- How's it going?- All right, a bit stressful.
0:39:29 > 0:39:32I think you're going to do some medical stuff with Aki,
0:39:32 > 0:39:36- and then we'll take it from there. - Ready?- Yeah.- OK, sure.
0:39:36 > 0:39:39Despite the 12 hours a day of being fed and monitored as a
0:39:39 > 0:39:43day patient on the unit, she was still losing weight.
0:39:44 > 0:39:47It had been decided she needed to come back into full-time care.
0:39:49 > 0:39:52- How are you feeling today?- Erm...
0:39:53 > 0:39:58Quite stressed. I'm just feeling a bit despondent
0:39:58 > 0:40:00that I'm doing this again.
0:40:00 > 0:40:04Feels like maybe you're not making progress?
0:40:04 > 0:40:07I just feel a bit embarrassed, like I've failed, really.
0:40:11 > 0:40:14She's somebody who has been ill for an incredibly long time.
0:40:14 > 0:40:19She's had lots of admissions to hospital and every time she leaves hospital,
0:40:19 > 0:40:22she loses weight really fast and really dramatically.
0:40:23 > 0:40:25Recovery takes a long time.
0:40:25 > 0:40:29People often have to go round and round more than once,
0:40:29 > 0:40:32through loops of, you know, restoring weight,
0:40:32 > 0:40:34having a go at losing, coming back round again
0:40:34 > 0:40:37before something works that helps them move on.
0:40:37 > 0:40:42Right, Jess. How do you feel about doing a squat for me?
0:40:42 > 0:40:44- Do you think you can do that?- Yeah.
0:40:46 > 0:40:47And back up.
0:40:48 > 0:40:49Well done.
0:40:55 > 0:40:58This past week, as I understand it, you've lost more weight.
0:40:58 > 0:41:00Do you think that's because you
0:41:00 > 0:41:02knew you were coming back in, in some way?
0:41:02 > 0:41:06You kind of start thinking there's no point in fighting
0:41:06 > 0:41:09because you know you're going to be, like...
0:41:10 > 0:41:15Force fed and have to eat loads of really scary foods and stuff
0:41:15 > 0:41:20and it's just, like, why put myself through the pain of forcing myself
0:41:20 > 0:41:23to eat, when I know what's coming?
0:41:23 > 0:41:28There's a safety net, almost like someone going in to alcohol rehab.
0:41:28 > 0:41:31In the week leading up, they're going to get as drunk as they can.
0:41:31 > 0:41:33As a last hurrah, almost.
0:41:36 > 0:41:39It takes a hell of a lot more strength to eat
0:41:39 > 0:41:42and recover from this illness, than
0:41:42 > 0:41:45it does, for me anyway, to indulge in it.
0:41:51 > 0:41:54This would be Jess's eighth stay as an inpatient.
0:41:58 > 0:42:00I'm really sorry that it's been such a struggle.
0:42:04 > 0:42:05I just feel like I need a break.
0:42:07 > 0:42:09Just some time out to clear my head.
0:42:11 > 0:42:13Sounds like you're struggling a bit.
0:42:18 > 0:42:19What's in your head?
0:42:25 > 0:42:29It's just so hard having to eat and deal with the feelings that that
0:42:29 > 0:42:32brings up and not have my usual ways of coping.
0:42:34 > 0:42:38And do you feel you are committed to your recovery?
0:42:38 > 0:42:41It kind of ebbs and flows at times.
0:42:42 > 0:42:45Like, I know I hate this illness, I hate my life at the moment,
0:42:45 > 0:42:48but I just don't really believe that I can recover.
0:42:53 > 0:42:55- I mean, are you OK? - Yeah, I'm OK.
0:42:55 > 0:42:59I just... I'm so sorry that you're going through this.
0:42:59 > 0:43:01Thank you.
0:43:07 > 0:43:11Jess has had this disorder for a long time now.
0:43:11 > 0:43:14How realistic is recovery?
0:43:14 > 0:43:16Part of what's difficult for Jess,
0:43:16 > 0:43:19part of the snag that pulls her back is the world's now quite a scary
0:43:19 > 0:43:22place. And you can kind of relate to that.
0:43:22 > 0:43:26If you think, if you've lived a lot of your life in and out of hospital,
0:43:26 > 0:43:28people telling you what to do all the time,
0:43:28 > 0:43:31your illness telling you what to do all the time,
0:43:31 > 0:43:34she's missed out on a lot of the normal development opportunities
0:43:34 > 0:43:38through which you kind of learn to feel more confident in yourself
0:43:38 > 0:43:42and how you manage the world. I don't think she's somebody who,
0:43:42 > 0:43:45she's going to come into hospital and this episode of admission
0:43:45 > 0:43:47is going to be, that's it, boom and she's suddenly recovered
0:43:47 > 0:43:49and everything's OK.
0:43:49 > 0:43:54I do think that this admission can contribute to her journey
0:43:54 > 0:43:57of getting to a place from which she can recover.
0:44:14 > 0:44:17It had been four weeks since I'd last seen Ifzana.
0:44:18 > 0:44:20In spite of the fact she was still sectioned,
0:44:20 > 0:44:22she seemed to be more engaged with her treatment.
0:44:22 > 0:44:24- Hiya.- Hello.
0:44:27 > 0:44:29How are you doing?
0:44:29 > 0:44:32OK, how are you? Been busy?
0:44:32 > 0:44:35- Yeah.- How's everything, have you had your hair cut?
0:44:35 > 0:44:38- Yeah.- See, I notice things.
0:44:39 > 0:44:41- Have you had a haircut?- No.
0:44:42 > 0:44:45But I changed it because it's, like, really hot,
0:44:45 > 0:44:47so it leaves my neck a bit cooler.
0:44:49 > 0:44:50What do you think of the banana drink?
0:44:51 > 0:44:53It's just a banana drink.
0:44:57 > 0:44:58What do you think of it?
0:45:01 > 0:45:03It's neither hot nor cold.
0:45:03 > 0:45:05SHE SNIGGERS
0:45:05 > 0:45:10- Don't tell that to the staff(!)- What is it supposed to be?- It's hot.
0:45:10 > 0:45:13- It's supposed to be hot?- Did you ask for it hot?
0:45:13 > 0:45:16I didn't really... I just said, "Give me what Ifzana's having."
0:45:16 > 0:45:17Well, then, it's supposed to be hot.
0:45:21 > 0:45:24I suppose I should just be grateful to have anything.
0:45:28 > 0:45:31I was curious to know if Ifzana was now more on board
0:45:31 > 0:45:34with the idea of being well.
0:45:34 > 0:45:36How do you feel you're doing?
0:45:36 > 0:45:38I definitely think things are moving forward.
0:45:38 > 0:45:40In what way?
0:45:40 > 0:45:43Well, obviously physically, my weight is obviously going up.
0:45:43 > 0:45:46Is it? I mean, you say, "obviously", I'm no expert but...
0:45:47 > 0:45:50And without prying in any way, so it is...
0:45:50 > 0:45:52You're sort of getting weighed regularly
0:45:52 > 0:45:54and they tell you it's going up,
0:45:54 > 0:45:56- is that right?- They don't exactly tell you.
0:45:56 > 0:45:58I kind of can see from the scales.
0:45:58 > 0:45:59- They show you the numbers.- Yeah.
0:45:59 > 0:46:01And how do you feel about the numbers going up?
0:46:01 > 0:46:04Well, I guess I'm always in two minds.
0:46:04 > 0:46:07The eating disorder part of me is obviously not thrilled,
0:46:07 > 0:46:09but the other side of me knows that it has to
0:46:09 > 0:46:11and I don't really have a choice.
0:46:14 > 0:46:17Ifzana had told me she'd been bullied as a child
0:46:17 > 0:46:20and that a few years earlier, she'd refused an arranged marriage.
0:46:22 > 0:46:25I wondered if she felt either experience had played a role
0:46:25 > 0:46:28in her illness, or whether the causes were more obscure.
0:46:29 > 0:46:31Where do you think it comes from?
0:46:31 > 0:46:33I think it's a mixture of things.
0:46:33 > 0:46:35SHE SNIFFLES
0:46:36 > 0:46:39I don't think there's one definite sort of pinpoint.
0:46:41 > 0:46:44Are you all right? I haven't made you upset, have I?
0:46:44 > 0:46:45- No, it's fine.- Have you got the sniffles?
0:46:45 > 0:46:47- Yeah, a bit.- Thinking about what?
0:46:53 > 0:46:54Everything changes.
0:46:54 > 0:46:56Everything... I usually don't like reflecting on things,
0:46:56 > 0:46:58especially with this whole process.
0:46:58 > 0:47:01It's kind of like... Because it obviously makes me upset and I can't
0:47:01 > 0:47:04- control it.- Oh... I'm sorry.
0:47:11 > 0:47:13- I'm really sorry.- It's not your fault.
0:47:27 > 0:47:31You are choosing to be here and I think you staying here
0:47:31 > 0:47:34is a kind of victory. I mean, I know you've got all different...
0:47:36 > 0:47:40..thoughts in your head, pulling you in different directions, but...
0:47:40 > 0:47:45Looked at in the healthy way, you're doing really well.
0:47:50 > 0:47:52The disorder's pulling you back, isn't it?
0:47:53 > 0:47:55There's a part of you telling you...
0:47:57 > 0:47:59..that you don't really want recovery.
0:48:01 > 0:48:05- And telling you that it feels wrong.- Yeah.
0:48:10 > 0:48:14One of the paradoxes of physical recovery from anorexia
0:48:14 > 0:48:17is that it can lead patients to feel worse.
0:48:17 > 0:48:20No longer numb, they have to face emotions
0:48:20 > 0:48:22they had suppressed by starvation.
0:48:23 > 0:48:25Often, this leads to relapse.
0:48:31 > 0:48:34The average recovery time from anorexia is seven years.
0:48:34 > 0:48:35Hello.
0:48:37 > 0:48:39It's hot out there, isn't it? Nice to see you.
0:48:39 > 0:48:42- How's it going?- OK. And you?
0:48:42 > 0:48:44Good.
0:48:44 > 0:48:46In the 40 years Janet had been ill,
0:48:46 > 0:48:49she'd never managed full recovery.
0:48:49 > 0:48:53- Hi, I'm Sophie.- Nice to meet you.- Nice to meet you.
0:48:53 > 0:48:56Hoping for some insight into why she'd found it so hard,
0:48:56 > 0:48:59I was joining her for a therapy session,
0:48:59 > 0:49:01which started with a weigh-in.
0:49:01 > 0:49:03- OK.- I've done well, haven't I?
0:49:03 > 0:49:04You've done very well.
0:49:06 > 0:49:07So you put a little bit on?
0:49:07 > 0:49:10Yeah, I'm not happy, so now I feel like I have to starve myself.
0:49:12 > 0:49:14I'm not happy.
0:49:14 > 0:49:18- I don't know why I've put on... - But it's- ..loads, haven't I?
0:49:18 > 0:49:20Not loads, Janet, but I think this is...
0:49:20 > 0:49:23- I have! I was...- This is very reflective, isn't it,
0:49:23 > 0:49:27of the two parts of you that we kind of identified?
0:49:27 > 0:49:29The part of you that wants this to get better
0:49:29 > 0:49:32and the part of you that's really anxious about that.
0:49:32 > 0:49:35From your experience in this field,
0:49:35 > 0:49:39do you have any sense of where this problem is coming from?
0:49:39 > 0:49:43I think, for Janet, this started a long, long time ago,
0:49:43 > 0:49:46at a time where maybe Janet felt she needed some control over something.
0:49:46 > 0:49:49I mean, Janet, would you agree with that?
0:49:49 > 0:49:52- 100%, yeah.- Control, why were you looking for control?
0:49:52 > 0:49:54Because I couldn't control anything else...
0:49:54 > 0:49:56In your life?
0:49:56 > 0:49:57- Why?- In my religion.
0:49:57 > 0:50:01I'm Jewish and in my religion in those days, 30 years ago,
0:50:01 > 0:50:0640 years ago, you had to get married young, have children and do well.
0:50:06 > 0:50:07I didn't want to get married.
0:50:07 > 0:50:10I didn't want to grow up, I wanted to be a child.
0:50:10 > 0:50:13I was terrified of going to work, terrified of leaving home.
0:50:13 > 0:50:15It all scared me so much.
0:50:15 > 0:50:17The anorexia was my best friend because I didn't have to do anything
0:50:17 > 0:50:19because I was sick all the time.
0:50:19 > 0:50:22It was my own little world that I could hide inside.
0:50:22 > 0:50:24I think there's probably a lot in that.
0:50:24 > 0:50:27It's come from my gut. Not all this psychological stuff.
0:50:27 > 0:50:29You just do not want to grow up.
0:50:29 > 0:50:31You're just too scared.
0:50:31 > 0:50:33You can't cope, end of.
0:50:35 > 0:50:40- Maybe the fact that I want to tell you to eat...- You're frustrated.
0:50:40 > 0:50:43I'm sort of, I feel like maybe that's another way...
0:50:43 > 0:50:45Maybe that in some level...
0:50:45 > 0:50:48- You're frustrated.- Is that how you want me to respond, maybe?
0:50:49 > 0:50:50So that I'm like a parent to you.
0:50:52 > 0:50:53He's good, isn't he?
0:50:53 > 0:50:54LAUGHTER
0:50:54 > 0:50:56No, I don't think so!
0:50:58 > 0:51:01Sometimes we do find that with anorexia there is something
0:51:01 > 0:51:05that keeps people stuck in it, where they do elicit lots of care
0:51:05 > 0:51:08from others. You know, maybe that's making up for something
0:51:08 > 0:51:10that they haven't quite had.
0:51:13 > 0:51:16I was struck by Janet's observation about not growing up.
0:51:20 > 0:51:21- This is you.- Yeah.
0:51:22 > 0:51:26It may be part of the seduction of anorexia that it keeps life
0:51:26 > 0:51:27at arm's length.
0:51:27 > 0:51:30That was my ex, a musician, Paul.
0:51:31 > 0:51:34- He looks groovy.- We got engaged. - What, and it didn't work out?
0:51:34 > 0:51:36- No.- Have you been married?- No.
0:51:36 > 0:51:38Engaged, twice.
0:51:38 > 0:51:39- And what happened?- I broke it off.
0:51:39 > 0:51:42- Why?- Eating with them became an issue.
0:51:42 > 0:51:43- Is that you?- Yeah.
0:51:43 > 0:51:46Eating became an issue in the relationship?
0:51:46 > 0:51:47- Yeah.- In what way?
0:51:47 > 0:51:49Because they said I wasn't eating enough
0:51:49 > 0:51:52and I didn't want to eat more and I had to sit down every evening,
0:51:52 > 0:51:55because we lived together, for a meal and I wasn't eating enough
0:51:55 > 0:51:57and it used to start arguments
0:51:57 > 0:51:59and I felt they were putting too much pressure on me.
0:51:59 > 0:52:03I didn't like it. I'd rather not have them and not eat.
0:52:05 > 0:52:08For those who feel a lack of control in their lives,
0:52:08 > 0:52:13anorexia offers the illusion of ultimate control,
0:52:13 > 0:52:16at the price of the years of missed opportunities.
0:52:22 > 0:52:26I was back in East London with an appointment to see Rosie,
0:52:26 > 0:52:29now living at home, while being treated as an outpatient.
0:52:31 > 0:52:34Of the people I'd met, she was the one who had seemed most confident
0:52:34 > 0:52:35of recovery.
0:52:36 > 0:52:38I wondered if things were still looking up.
0:52:43 > 0:52:45- Hello.- Hello!
0:52:45 > 0:52:48- How are you doing?- Good, how are you?
0:52:48 > 0:52:52Yeah, good. I was going to say, you look great and then I was like,
0:52:52 > 0:52:54"Hang on, I don't even know if I'm supposed to say that."
0:52:54 > 0:52:58- Different?- You know, what is it therapeutically advisable to say?
0:52:58 > 0:53:00You look...how you look.
0:53:00 > 0:53:02- That sounds weird.- Yeah.
0:53:02 > 0:53:03I think I know what you mean.
0:53:03 > 0:53:05- Yes.- Come in.- How are you doing?
0:53:05 > 0:53:07Yeah, I'm well.
0:53:07 > 0:53:08I'll come in.
0:53:08 > 0:53:12- Nice to see you.- Yeah, you, too.- Cheers.
0:53:13 > 0:53:15- You've been discharged now. - Yeah, officially.
0:53:15 > 0:53:17Obviously, they gave me the two-week trial.
0:53:19 > 0:53:23I done the first week and my weight had stayed the same,
0:53:23 > 0:53:24but that was a positive.
0:53:26 > 0:53:31Then I done another week at home and I had gained 0.7, so...
0:53:31 > 0:53:33Wow. That's great, congratulations.
0:53:33 > 0:53:35Thank you.
0:53:35 > 0:53:38Some of the people I speak to, who have eating disorders,
0:53:38 > 0:53:43they're much more in two minds about putting on weight
0:53:43 > 0:53:47or looking more healthy.
0:53:47 > 0:53:49Yeah. I know I need to do this,
0:53:49 > 0:53:51I know I need to put on the weight because otherwise...
0:53:51 > 0:53:52I really do not want to go back there.
0:53:52 > 0:53:55I do not want to step back in that ward.
0:53:55 > 0:53:58And I'm motivated, you know?
0:53:58 > 0:54:01I know where I've been before and I know I can do it, but...
0:54:02 > 0:54:05It's just, you know, you are always in two minds.
0:54:05 > 0:54:08If I've taken away anything from all of this, it's that the healthy
0:54:08 > 0:54:10and the unhealthy impulses get intertwined
0:54:10 > 0:54:15to such an extent that it's sometimes hard to separate the two.
0:54:15 > 0:54:16Yeah.
0:54:26 > 0:54:27MICROWAVE BEEPS
0:54:30 > 0:54:33Rosie's future was hard to predict.
0:54:33 > 0:54:37I could only hope that she would be among that group of patients
0:54:37 > 0:54:40who make a full recovery and return to the normal life
0:54:40 > 0:54:43she'd known only a year before.
0:54:59 > 0:55:01Are you still going to watch me eat?
0:55:01 > 0:55:04- Is that going to make you uncomfortable?- Yeah, I'd rather not.
0:55:04 > 0:55:06- Really?- Yeah.
0:55:07 > 0:55:09- You want me to leave?- Sorry.
0:55:25 > 0:55:27She doesn't want us there when she's having her tea.
0:55:29 > 0:55:31It's still stressful for her.
0:55:31 > 0:55:33Very stressful, indeed.
0:55:33 > 0:55:34Very, very stressful.
0:55:34 > 0:55:36She's still battling.
0:55:36 > 0:55:38Yeah.
0:55:38 > 0:55:39In her mind, she is, yeah.
0:55:39 > 0:55:41- Would you agree, Heather?- You know, like, she goes,
0:55:41 > 0:55:43"I can't do this no more. I can't..."
0:55:43 > 0:55:47I say, "Deep breath, count to ten,
0:55:47 > 0:55:50"think of something nice and that feeling will go."
0:55:50 > 0:55:51And that's what she does.
0:55:53 > 0:55:56She gets upset sometimes because she thinks she's failing again.
0:55:57 > 0:56:00You think there's a little voice in her still saying,
0:56:00 > 0:56:02"Don't put on any more, you've done enough?"
0:56:02 > 0:56:06- No, she knows.- That voice is still there, I think.
0:56:06 > 0:56:08- I think so.- A little bit.
0:56:08 > 0:56:12You don't have it to that extent for all those months
0:56:12 > 0:56:14and then have it go like that.
0:56:14 > 0:56:16No, that's right. I think it's still...
0:56:16 > 0:56:18- Oh, yeah.- It's still there.
0:56:18 > 0:56:19- It's still there.- It's lurking.
0:56:19 > 0:56:21- Yeah.- Yeah.
0:56:21 > 0:56:24But she'll get there. I can see a big, huge difference.
0:56:24 > 0:56:26And you think she's serious.
0:56:26 > 0:56:28- Oh, yeah.- About doing it?
0:56:28 > 0:56:29- Oh, yeah. Definitely.- Definitely now.
0:56:29 > 0:56:33She said to me, "I never, ever want to go back, ever."
0:56:37 > 0:56:38DOOR OPENS
0:56:39 > 0:56:40- Hello.- Hello.
0:56:44 > 0:56:47- I keep forgetting you've had your hair done!- Yeah.
0:56:50 > 0:56:52We were talking about you.
0:56:52 > 0:56:53I thought my ears were burning.
0:56:56 > 0:56:57- Good, I hope.- All good.
0:56:57 > 0:56:59Yeah.
0:56:59 > 0:57:03- Of course.- It's not always good, so I don't know why you're pretending.
0:57:03 > 0:57:06- No, it was. It was all good.- OK.
0:57:19 > 0:57:23Do you think that it's part of the human condition in some way?
0:57:23 > 0:57:26I mean, it's always been with us and will always be with us.
0:57:26 > 0:57:28Yeah, I think both. I think it's always been with us,
0:57:28 > 0:57:32it will always be with us and there are things about our culture
0:57:32 > 0:57:35currently that increase the prevalence.
0:57:37 > 0:57:41So the genetic vulnerability we're born with interacts
0:57:41 > 0:57:45with the experiences that we have as children and growing up
0:57:45 > 0:57:48and those are experiences of family, experience of peer groups
0:57:48 > 0:57:50and the social world that we live in.
0:57:50 > 0:57:54But the interaction between all of these factors, for some,
0:57:54 > 0:57:56will trigger the illness.
0:57:56 > 0:58:00Anorexia is an illness associated with appearances.
0:58:01 > 0:58:04But in my time speaking to people with the disorder,
0:58:04 > 0:58:07I've been struck by how much it had to do with the deepest feelings
0:58:07 > 0:58:10of powerlessness and lack of self-worth.
0:58:17 > 0:58:20It intertwines itself with positive qualities,
0:58:20 > 0:58:23like conscientiousness and self-discipline
0:58:23 > 0:58:25and makes them poisonous.
0:58:25 > 0:58:29Demanding from those who have it, a daily heroism in facing down
0:58:29 > 0:58:33an illness often indistinguishable from their own selves.