It was absolutely essential that Fiona informed our family doctor of her concerns. Helen had initially been about 16 pounds overweight at 7 stone 12 and so when she began to slim down to a trim 6 ½ stone I was not at all concerned. Fiona, however, already had reservations owing to her family medical history, as mentioned in the last section. After the initial diagnosis by our doctor, it took about a month for the health services to set up Helen’s medical programme. By this time, Helen had lost another 4 pounds! This is one reason why early detection is essential. But the main reason for early detection is to avoid the problem becoming entrenched and developing into a way of life. Established habits are much harder to break.
At Helen’s first meeting with her counsellor, Helen was described as well-balanced. However, by the time of her second meeting, a couple of weeks later, the scene in our kitchen had taken place and Helen had experienced her severe mental breakdown. Counselling continued for about four months at the rate of one session every one or two weeks. Needless to say, it had very little impact on Helen and played no appreciable role in breaking the anorexia. This was not as a result of any failings on the part of Helen's counsellor - she was very caring and professional - but anorexia is a 24/7 condition and one hour’s counselling per week is not going to resolve it. Between us, we had to be prepared to be there for Helen at any time of the day or night that she needed us for the foreseeable future. We both recognised that breaking Helen’s anorexia was our first priority and our first responsibility.
However, the counselling was of value in that it allowed Helen’s counsellor the opportunity to evaluate whether there were any circumstantial factors perpetuating the anorexia, e.g. abuse. Had we objected to the counselling on the basis that it was a waste of time, it inevitably would have aroused suspicions and the whole situation might have been taken out of our control. Besides which, there might have been a circumstantial factor that we were unaware of, e.g. bullying at school, and counselling could have brought it into the open. In Helen’s case, there were no such factors and so recovery could take place immediately. As well as counselling, Helen was also assigned to a psychiatrist who actually saw very little of Helen but did spend a number of sessions analysing Fiona and myself, presumably to evaluate the extent to which we were the cause of the problem and the extent to which we would be able to assist or hinder Helen’s recovery. Again, this was an important aspect of the service provided by the health authority. Fortunately, Helen’s psychiatrist was willing to allow us to introduce our radical proposals despite his reservations. Unfortunately, our strategy initially failed to produce any positive results and, in fact, Helen lost another 7 ounces. It was at this point that he called the emergency meeting that I referred to earlier. At the time of calling this meeting, he had major concerns about a number of aspects of our plan, namely, the intensive exercise programme and the rigorous calorie counting. After all, these are the tools that an anorexic uses in order to lose weight. Our aim was to use these practices to destroy the anorexia and so facilitate weight gain and psychological reconstruction.
Helen’s weight, by this time, was approximately 5 stone 6 and remained at this level for around about 6 weeks. In other words, we had stopped the anorexia reducing her weight any further before any real physical damage had been done. This was a major achievement because without our intervention the anorexia, which was reducing Helen’s weight at the rate of a pound a week, would have diminished Helen to a mere 5 stone which would have been life-threatening.
In retrospect, this stabilization of Helen’s weight was very possibly a crucial factor in her recovery because it allowed us to re-establish a regular eating pattern and to demonstrate that food was not the threat that the anorexia had misled Helen into believing. She had eaten a supermarket trolley worth of food during that 6 week period and had not gained a pound - so what was there to be scared of? It was, therefore, possible to eat and still not lose control of your weight until you became the thing that you most feared being - even beyond death itself - fat!
However, Helen’s psychiatrist did not view it this way. He felt that the longer she remained anorexic, the more difficult it would be for her to recover and he was extremely concerned at this further loss of 7 ounces. This was compounded by his frustration at the fact that she was not steadily gaining weight. His goal had been a weight gain programme of around a pound per week and so Helen should have been close to 6 stone by now. He was unconvinced by out justification of the status quo we had attained with regard to Helen’s weight, dismissing our arguments that we had made very real psychological progress in having re-established a regular eating pattern. His continual rebuttal of our achievements was expressed via the rather unfortunate metaphor - “the proof of the pudding is in the eating.” Had Helen’s body weight fallen much lower than the 5 ½ stone that it had reached when her condition was first diagnosed, then he may well have been right as such a low weight could have been immediately life-threatening. But, in Helen’s case, I now firmly believe that the initial rapid weight gain that the psychiatrist desired may have been detrimental to her recovery as it would not have allowed Helen the opportunity to learn that she could eat and still maintain control of her weight.
At that time, we were also equally frustrated at our inability to make Helen recover her body weight but my argument was that it was not the way that we were going about it that was at fault, i.e. calorie counting and exercise - but that we were simply not managing to get a sufficient number of calories into her and, therefore, we needed to rethink the calorie targets that we were setting for Helen. The third person from the medical profession involved in Helen’s rehabilitation was Helen’s dietician who was absolutely crucial to assisting Helen’s recovery. However, at this point, she was working on the methodical approach of Helen gaining one pound each week. This was practical in the sense that every pound gained was a terrifying and distressing prospect to Helen and, therefore, weight gain had be gradual. Helen’s weight continually fluctuated up and down by anything up to a pound during the first couple of months of her recovery which is why there was no appreciable net weight gain. Each visit to the dietician was a nightmare. We were continually concerned that she might have failed to gain weight or -even worse - could have lost weight. She was terrified of having put on weight and on those occasions where she had temporarily gone up a pound, she would spiral into terrible depressions. These depressions clearly demonstrated the ruthless power of the anorexia in its quest to destroy her.
But the main reason for the stagnation of Helen’s weight was the impracticality of forcing someone to gain no more than one pound per week. Therefore, we had to negotiate a new goal of Helen putting on no more than four pounds in a month. This was far more attainable as it allowed us to overshoot for a few weeks - say three pounds in two weeks - and then reduce the calorie count for a week to compensate for the over-shooting. If, at the end of the month, Helen’s total weight gain had remained at just the three pounds, then we would all have heralded that as a great success. As a result of this change in time-scale, Helen started to make rapid progress in regaining weight. Helen’s dietician was crucial in calculating the target weight that we were to aim for and in working out how many calories Helen needed in order to gradually increase her body weight to reach that target. That target weight was to be based on a child BMI of 21. By the dietician’s estimation, Helen required 1200 calories a day to stay where she was and 1600 calories per day to put on a pound per week. Given that exercise was a crucial aspect of our recovery programme, additional calories had to be added on depending on the day’s exercise programme.
We were also quite open with Helen about what we intended. We sat her down and explained to her the dietician’s calculations regarding calories and even bought a £40.00 electronic kitchen scale that measured to the gram as it was essential for Helen to feel that she was in control of her impending weight gain. The dietician also explained to us the importance of removing the bathroom scales as these had become an integral part of the obsession. Helen had got to the point where she would be jumping on and off them several times an hour. As we were desperately trying to persuade her to eat and drink, the last thing that we needed was for her to be weighing herself before and after each meal, and then becoming hysterical because the weight of the meal was registering on the scales. Thus weighing became a weekly ritual under the strict supervision of the dietician. And anyway, one weigh-in a week was stressful enough! Possibly the most important reason why it was necessary to involve the medical authorities rather than go it alone was that in order to counteract such a powerful mode of thinking and behaving as anorexia we desperately needed a sanction. I had read a book about eating disorders which warned against turning mealtimes into battlegrounds. I couldn’t agree more. Mealtimes should be as stress free as possible given that you are trying to reintroduce a healthy approach to eating. But given the fact that Helen was terrified of eating and that we had to induce her to eat a certain number of calories each and every meal time, it would have been impossible to structure her recovery without a lot of battles. Fiona had taken Helen to see an NLP(neuro-linguistic programming) practitioner at £80.00 per hour who had forecast that after 3 sessions with him, we would really see the difference. He was very confident that he could employ certain suggestive thought techniques which would undermine the anorexia and make Helen desire to get better. Through eliminating negative thoughts, he would be able to help her to regulate her emotions. He gave up after the third session but did stress the importance that the desire to eat had to come from Helen. This was advice that we readily ignored. As we explained to Helen, she did have a choice - but it wasn’t to choose whether or not she wanted to eat because we already knew the answer to that one. After all, she did not believe that she was even ill. As she said herself: “I’m not anorexic. I’m right!” The choice we gave her was between eating and recovering under our regime - or between eating and recovering under a force feeding programme in hospital. During the first three months of Helen’s recovery (March to June 2003) each meal time was a potentially unnerving experience for Fiona and myself - and frequently a terrifying experience for Helen. There were a number of occasions when she became defiant or hysterical and simply refused to eat. As I mentioned in the introduction to this website, the anorexia initially had total control over Helen. Therefore, in order to make her eat the meals that Fiona had carefully prepared along the dietician’s guidelines, we needed an ultimate sanction - and that sanction was provided by the medical service. The psychiatrist had arranged for a hospital bed to be made ready for Helen. He had planned to tell her that she would be forcibly admitted were she to lose a few more pounds and fall to a weight of about 5 stone 4. However, we persuaded him to tell her that she would be hospitalised were she to fail to put on weight at the rate of 3 to 4 pounds per month. The danger of allocating a set weight for hospital admission was that she would cling to a weight just above it and therefore would stagnate at that weight. We wanted a sanction that enforced progression. Therefore, on the few occasions when Helen did point blank refuse to eat, one of us reached for the telephone with every intention of having her admitted for a week or two.
Helen was terrified of being admitted and force-fed in hospital because she would lose all control over the situation. She would not be in a position to monitor her calorie intake and exercise would have been forbidden. Therefore, we were able to enforce her compliance with our recovery plan. Without this ultimate sanction, I don’t see how we could have helped Helen. It enabled us to make our strategy acceptable to her and, therefore, allowed us to effect a rapid and permanent physical and psychological recovery as opposed to a period of weight gain in hospital followed by the very real potential for relapse some time afterwards because food, rather than anorexia, might still be regarded as the enemy. The psychiatrist and the dietician were also invaluable to Helen’s recovery in that we could use them as scapegoats and thus deflect some of Helen’s initial rage at being forced to eat. We often negotiated the basic daily calorie target for a particular week with Helen’s dietician before attending our weekly weigh-in but left the dietician with the unpleasant task of announcing it to Helen - especially if that target had to go up. Then we could blame the dietician.
We particularly utilised Helen’s psychiatrist in this way as, professionally speaking, he had overall responsibility for Helen’s recovery. If Helen continued to frustrate our attempts to make her gradually regain a healthy weight then, we informed her, he would hospitalise her. This deflection of blame was very useful as it did make it much easier for us to continually make the hard choices that we had to make for Helen’s sake and did genuinely deflect some (but certainly not all!) of Helen’s anger.