There’s a never-ending amount of reading I could do in relation to my work. Literally, never-ending – text books, journal papers, even Twitter threads. But I so often default to memoir for understanding. Yes, it’s only one person’s account but it’s the personal nature of that account that makes it meaningful. Case in point is a scene from Hadley Freeman’s memoir about her battle with anorexia, Good Girls – she’s 15, and with her family at a restaurant –

…I was hungry. God, I was so hungry. And so I ordered my favourite dish and, before I knew it, I’d eaten almost all of it, and when I stopped to take a breath and saw the empty bowl, I screamed inside. My family smiled happily at me, and my parents looked at each other with a ‘There, all sorted’ look on their faces. They were happy, and that was better than them being angry at me.

I don’t know all that much about disordered eating, but to me, that one quote captures the turmoil, the shame, and the pressure.

In Good Girls, Freeman reflects on her own experience, and combines it with current research and treatment for anorexia.

It is now widely understood that anorexia is a mental illness that manifests physically (in fact, one of the few that is physical). Freeman states –

I believe that eating disorders are about control, and when someone is struggling with control, the control can get displaced onto their eating.

More specifically –

…when an anorexic says, ‘I don’t want to be fat, I want to be thin,’ they are saying, ‘I want to be other than I am, and what I am is unhappy. I want to be someone else.’ And once you understand that, you understand that the trigger is not the point, because when a person is that unhappy, anything can be a trigger.

I was reminded of Rachel Aviv’s Strangers to Ourselves, where she quotes the [anorexic] poet, Louise Glück – ‘The tragedy of anorexia seems to me that its intent is not self-destructive, though its outcome so often is. Its intent is to construct, in the only way possible when means are so limited, a plausible self.’

Freeman’s eating became disordered at age 14, and for the following three years she was in and out of hospital. What is most striking about her story is how all-consuming the illness was and not just for her, but her family as well. On how anorexia changes people, she says –

…good little girls become liars, cheats and terrors. Once people-pleasers, they now cause enormous pain to those around them, and they refuse to stop doing so.

She notes that she’s never met a mother of a girl with anorexia who doesn’t, on some level, blame herself for her child’s illness. Yet here’s the paradox for families – ‘…if those around the sufferer collude in making her world just about anorexia, how will she know there is a life beyond it?’

Freeman discusses what prompted her ‘recovery’ –

Not the pleading, the reasoning, the anger or the crying, all of which bounced off my anorexia shield. Instead, it was comments about what my life would be like, if I wasn’t otherwise engaged with starving myself.

She began university and, although her disordered eating remained, she channeled her energy into her studies (rather than starvation).

I was spending sixteen hours a day learning French vocabulary and the dates of Renaissance paintings, but only six months earlier I could never have imagined such freedom.

As mentioned, Freeman’s story is woven around current research about anorexia. The science is interesting. Fluctuating hormone levels in a ‘starving’ brain create a vicious cycle –

…anorexics often suffer from memory and learning deficits, and because starvation is (to say the least) stressful, they have increased levels of the stress hormone cortisol and therefore lower levels of of serotonin… In other words, anorexia starts as as a psychological problem, becomes a physical one, and the physical problem then exacerbates the psychological one, and vice versa… Not eating damages the organ needed for change.

And then you add the hormonal complexities of adolescence into the mix –

It is very difficult for sufferers in adolescence to get above 41kg, because at that weight your hormones start being released and all the feelings come rushing back, and they want to push them down. So 40kg becomes the glass threshold that you can’t get through.

Incidentally, anorexia has the highest mortality rate of all psychiatric illnesses, yet doctors still can’t predict which patients will recover, and which won’t. ‘Recovery’ takes approximately ten years and of those that ‘recover’, generally one third of patients fully recover, one third may survive but struggle with difficulties, and one third live with chronic anorexia (effectively a maintenance of malnutrition).

Freeman is a terrific writer (whether she’s taking a deep dive into Dirty Dancing or discussing hospital stays). The message in this book is clear – there’s no magic bullet; it’s a long haul; and those around the person with anorexia have to find a balance between supporting them and not pandering to the rigid, unyielding demands of the illness.

I’ll finish with another quote that will stick with me (a good reminder that despite education and improved knowledge, there are still plenty of fuckwits out there) –

One psychiatrist told me I’d developed anorexia because I had been born by c-section, ‘so you always try to look for the easy way out,’ he said. I was fifteen years old, under five stone, manic with hunger, and I looked at him and thought, ‘You think this is easy? Let’s see you try it pal.’

4/5

I fantasised extensively about what my life would be like… I’d have a boyfriend who would drive me around in a convertible, we’d meet my friends for dinners in cafes where he would feed me French fries and I would laugh and eat them with adorable abandon. My fantasies were heavily dependent on me suddenly not being anorexic and turning into a character from Beverly Hills 90210.