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