One morning eight years ago, Clara Hand got up to use the bathroom in her Dublin home and collapsed. Recently the regimen she had developed herself and had been following diligently had finally been given a name — anorexia. She was put on a list to be admitted to a bed to treat her disorder, however she was still struggling to accept she was actually sick, or certainly as sick as the doctors thought she was.
She says: “One morning I got up and felt very unwell. I had been taking laxatives so often that I couldn’t remember if I had taken them the night before. I was doubled in pain, I held the toilet and got sick. Then I collapsed on the floor. What scared me the most is when I tried to call for my mam, I couldn’t make a sound. I couldn’t move. I remember thinking, ‘Maybe I’ve taken this too far. Maybe I’m not ok’.
“I tried to call my mam again but, again, I couldn’t speak. I remember trying to kick the side of the bath and she shouted in: ‘Are you ok?’ However I still couldn’t answer. So I managed to kick the bath again and a shampoo bottle fell so she came in and I was lying on the ground. She got a terrible fright. She wanted to call an ambulance but I was adamant. I knew they’d keep me in.”
Anorexia has long been misunderstood. It is sometimes characterised as a rogue response to images of skinny people, an affliction of narcissists, a disorder of aspiration. But it is a mental illness, one that is often thought of as simply an eating disorder. It affects 10pc of all eating disorder sufferers, but has the highest mortality rate of all mental illnesses in adolescence.
And as it is a mental illness, it is now being treated with greater understanding that, to sufferers, an eating disorder can represent a refuge from uncertainty or a response to a perceived loss of control. In Clara’s case, a close family member suffered from alcohol abuse. To her, their entry into rehab was a destabilising factor.
She adds: “I was extremely proud and happy they were making these changes but what I needed to see was consistent progress. I didn’t trust that things would be different. I didn’t feel comfortable handing over the responsibility I felt. I really didn’t feel ready to hand that over.”
The collapse came roughly a year into Clara’s illness; her symptoms, by now, obvious. She had become more insistent in adhering to schedules and irritable with anyone who attempted to intervene. Her mother persisted, though, taking Clara to her GP, who referred her to the Child and Adolescent Mental Health Services (CAMHS). She was, they said, an emergency case.
Clara was admitted to hospital within a month. She was 15, with a weight so low that her BMI didn’t register on the clinical chart. And yet, she remained sceptical of her diagnosis.
She says: “I was so mortified about missing school. I said to my mam, ‘Tell people I got pregnant and I’m away having the baby’. I didn’t realise how unwell I was until hospital. It took being there for me to come to terms with what I was doing to myself.”
On her first day she asked the nurses if she could take a shower. Their answer was no. She describes remonstrating with them, saying they should be pleased that she wanted to take care of herself. She was informed that firstly, she was too weak and secondly, the nurses believed she would exercise in the shower. Damn, she thought. How did they know?
For the first few weeks she was closely monitored. She took her meals with nurses rather than her peers, and was only allowed to leave the table once the food was gone, sometimes taking an hour-and-a-half to finish a meal. She describes eating her first hospital meal of chicken curry while sobbing.
“All this time I’d be putting up this front of ‘I’m fine’, then I’m there crying in front of this stranger,” Clara says. “From that moment for the whole three months I didn’t argue, I ate every single meal. Eating meant that I was going to start to feel better. I wasn’t sure what better meant or looked like but I figured nothing could be much worse than where I was.”
A series of small but significant milestones charted Clara’s recovery — sitting down to lunch with her peers, an afternoon out of hospital, a half-day at school, a night at home. Upon discharge, she was overjoyed, if slightly overwhelmed.
Hospital, she says, was “sheltered”. “There were nurses on hand 24/7, there was loads of support.” She had CAMHS appointments once a week and still observed certain limitations. PE classes at school, for example, were forbidden until her recovery was assured. As is the case for many, Clara’s process of recovery was not linear, nor was everyone understanding.
She adds: “I was bullied in transition year and fifth year. I didn’t really go into school in fifth year at all. I was having panic attacks. I would have been really underweight at the time. The eating disorder, unfortunately, was a coping mechanism. I left school at 17 and went to Youthreach and even after leaving school I got abuse. There were statuses up on Facebook that I wasn’t going to amount to anything, that I’d end up working in McDonald’s.
“I came from a background which wouldn’t be offended by that — at least you have a job! The abuse made me more determined to succeed. I knew my road was going to be harder but I also knew I had come further.”
In part in recognition of the team who helped her through her disorder, Clara wanted to be a psychiatric nurse. After Youthreach she went on to do a PLC course and from there, to university. The 23-year-old is currently interning and this autumn, will graduate in psychiatric nursing.
Undoubtedly her skills will be in demand in the coming years as the psychiatric services grapple with the fallout of the pandemic. Also, there has been a huge rise in eating disorders among young people seeking to impose some order on lives torn apart by Covid-19. As counter-intuitive as it might seem, it is control rather than vanity which is often the impulse of sufferers.
Ranae von Meding (33) eating disorder survivor
Campaigner Ranae von Meding seeks to tease out the questions surrounding these issues in Disordered: The Podcast, as someone who understands the nooks and crannies of eating disorders, having suffered herself for many years.
“I first developed an eating disorder when I was 16, I’m now 33. So I’ve been living with it for nearly two decades,” she explains. What started initially as anorexia developed into bulimia and while people did ask if she was ok, she always deflected the question.
“At times, yes, my weight was very low, but at times it was very normal. Or maybe even over my normal weight. And if you’re not severely underweight then sometimes people just don’t see it. They think, ‘Oh, they’re fine, they’re fine’. So I was just very good at covering my tracks and being like, ‘Oh there’s nothing wrong with me. What are you talking about?’ That was all through my early 20s.”
For a time, she says, she would be “ok in inverted commas”. “I wasn’t necessarily planning a binge every day — which I would absolutely do in bad periods — but my eating was very much disordered. I could maybe go a week with semi-normal eating habits but my mental health was not good. It got to a breaking point. I was just so desperately unhappy, just desperately not wanting to be here anymore. I was never suicidal but I absolutely did not enjoy my life,” Ranae adds.
“It was so bad that if I didn’t find a way out of it, I was afraid I would die. I had to make a choice. That was when I contacted my GP and I was referred for outpatient therapy. I was bounced around a number of therapists before I landed with the one who helped me to save my own life. I would 100pc not be here today if I hadn’t asked for help.”
Ranae, who has two children with her wife, Audreny, says that it was the prospect of bringing children into an emotionally chaotic situation which finally resolved her eating disorder for good.
However, she says that the common characterisation of eating disorders sufferers as being “skinny white girls” is misleading and outdated. It also means that sometimes sufferers are not taken seriously. But where treatment provision is concerned, the landscape is improving, says Harriet Parsons, who is training and development manager at Bodywhys.
“Traditionally there would have been something of a postcode lottery,” explains Parsons. That was identified in [mental health policy document] A Vision For Change years ago. The HSE started the process by developing clinical care programmes for three mental health issues and this was one of those.”
What came out of that process is a National Clinical Programme for Eating Disorders. The initial proposal was to establish 16 multidisciplinary teams to deal solely with eating disorders referrals, so patients would be referred directly by GPs. Each hub of specialists would serve the same population size. Where the population was inadequate, the local CAMHS team would incorporate the specialism.
This model of care was launched in 2018. Since then, three such teams have launched; one adult team and two CAMHS specialist teams. Unfortunately after this, the funding was diverted to plug holes elsewhere in the mental health budget. This funding has since been reinstated and ring-fenced.
Parsons notes that the recruitment process had already begun so some of the clinical specialism required to bed down the teams is already in the system. Parsons stresses the importance of reaching out and asking for help and the power of early intervention.
Clara adds that there must be more discussion of the agonies of the disorder. “The parts nobody talks about,” she says. “I couldn’t wear a bra because of the pain of the strap. I couldn’t sit on a chair that wasn’t cushioned. I could never stay warm. It was such a miserable time. I’d lost all this weight, but what had I achieved? I didn’t even look good.”
In telling her story, Clara hopes to encourage more sufferers to seek help. She says: “Reach out, even if you don’t think you’re sick or you don’t think you’re sick enough, that doesn’t matter. Talk to someone, a friend, a family member or a teacher you trust. If I told someone how I was feeling I would have prevented how unwell I became.”
Disordered: The Podcast is on Apple Podcasts