Popped into my local coffee shop today and was greeted by the guy behind the counter (I refuse to say ‘barista’, just like I refuse to order a venti or grande. This is Eastbourne for Pete’s sake, not Venice). Anyway, he was asking me about the holidays and said, ‘You look great! Haircut…no, don’t tell me, you’ve lost weight!’ Au contraire, my friend, I’ve gained, but I’ll take the compliment in the spirit in which it was intended.
It’s funny isn’t it, that losing weight is seen as shorthand for looking good. ‘You look fab – because there’s less of you!’ But to be honest, his comment made me feel quite good. Not the losing weight stuff (that’s a cultural nicety along the lines of ‘have you been working out?’), but the fact that I’m back in a world where I look normal, rather than skeletal. It feels like quite an achievement. I can remember going out for a coffee with mum a few years ago, when I was at a very low weight. I couldn’t understand why Mum spent the entire time glaring at other people and on the verge of tears. (Unlike me, she was aware of how terrible I looked and the comments being made about us by the people around us). The memory of it still haunts her.
I was reminded of this by an article in yesterday’s Times, (‘What makes an anorexic?’). In it Rosemary Metcalfe recalls taking her daughter Katie out for a weekend visit from the hospital where she was being treated for anorexia. A stranger approached her daughter and said, ‘people like you shouldn’t be allowed out in public’. Rosemary relates how she ‘started screaming like a banshee. Katie did look awful..but I couldn’t bear someone who didn’t know her judging her and, by implication, judging me’.
One of the theories behind the causes of anorexia is that of the pushy, overprotective mother whose own obsession with weight and expectations drives her daughter to starve. This – or some kind of family dysfunction or abuse may be part of the picture. But equally, it may not. For starters, no family is perfect – in fact, every parent I know feels that they could do a much better job. Within the family unit, the father-daughter relationship would seem to me as significant as that of the mother and daughter – even if it is marked by absence as opposed to cruelty. This is not to deny the existence of, or to excuse those families where abuse has taken place, (research suggests 3 out of 10 anorexics have been sexually abused ). But it is to suggest we are careful before equating eating disorders with such specific causes.
When I was being treated, I remember being questioned repeatedly as to whether or not I had been abused. Thankfully this was not part of the picture for me (far from it), but it was upsetting and made me feel that I was hiding something, or letting my therapist down. What it did to my parents must have been even more distressing. Now of course such investigations must be part of treatment, but done sensitively, and not posited as the only explanation.
In fact, experts talk of three kinds of factors that are at work in the development and maintenance of eating disorders. These are predisposing factors (such as a perfectionistic personality type), precipitating factors (e.g; the onset of adolescence, bullying at school etc) and perpetuating factors , (cultural approbation given for weight loss, etc). Rarely is one single factor the ’cause’ of such behaviour, however neat or convenient an explanation it provides.
Instead such stereotyping may oversimplify a complicated disorder and put already beleagured families under unbearable strain, precisely at the time when they need most support. Anorexia is an incredibly selfish and destructive disorder. It tears families apart. Growing up, the years that I was in treatment placed our family under an incredible strain. Like it or not, most of the family’s time, money and energies went into me. But I had a younger brother and sister with their own struggles, not to mention two adults with their own relationship outside of their crazy daughter. Even now, I think those years have left scars on our family and gaps that can’t be filled.
Metcalfe comments on the impossible position in which mothers of anorexic patients are often placed. ‘We were never pushy parents’ she says, ‘but when you have a child who is ill, particularly with anorexia, you think, ‘what have I done wrong? Could I have spotted it sooner?…I think certain professionals looked at us and thought ‘domineering mother’ or ‘dysfunctional family. But we had an ill child, so we were demanding help. Does that make you a domineering mother?’ For this reason, the pushy parent stereotype may be the outcome rather than cause of the disorder. But if you were watching your beloved child starve themself to death, wouldn’t you do the same?
As part of my treatment, it was suggested that we attend family therapy. Amongst other things, this would have involved the whole family interacting behind a two-way mirror on a weekly basis, with a team of experts monitoring our conversations and interactions. My parents refused to do this, wanting to protect my brother and sister from further upheaval. Whatever your opinion on the best course of action, it was patently not an easy or clear-cut choice. It’s worth remembering that with eating disorders as with many other mental illnesses, the ‘solution’ can seem to be much more obvious than it actually is. Leaping in with a solution or labelling ‘the’ problem is rarely what those struggling actually need. Particularly when the causes of such dysfunctions are placed at the door of those who are trying to cope with them.