“Caroline doesn’t have Anorexia. She weighs too much.” My psychiatrist explained to my mother, on his first visit to me on the hospital ward.
My mother wasn’t too convinced. She told him all about how I was checking the packets on the food she gave me when I visited her house (she’d left me and my Dad at this point.) She told him how I refused to eat certain things I once enjoyed eating. The baggy clothes, the feeling cold all the time, the obsessive ranting about how I needed to lose weight. The stealing of her partner’s Thyroxine medication (I thought I wouldn’t get caught doing that). She told him everything.
“Mrs Murphy, everything you’ve told me is circumstantial, and can only be related to her clinical depression. People who have depression lose their appetites, they wear clothes that keep them cocooned in their comfort zone, they steal medication to stock – pile for a future overdose. Based on Caroline’s BMI and weight, I’ve concluded that she doesn’t have an eating disorder. Yes, I agree that she’s slightly underweight, but only slightly.”
I was beginning to feel invisible in the room, while this conversation was taking place. My next feelings were, “he’s saying I’m fat.”
I’d been obsessing over my weight for around 3 months, prior to my suicide attempt. But more than that, I’d been playing a sort of game with myself too. I would see how long I could last without eating anything, and if I beat the previous day’s “high score”, I’d reward myself with a piece of fruit, or a piece of dry toast.
I was skipping school at this point, so I didn’t have to face the ordeal of explaining to my friends why I wasn’t eating my usual calorific chip muffins, or chips and gravy combos from the chip shop at lunchtime. Instead, I would sit at home and suppress the urge to raid the cupboards. I chain smoked to suppress my appetite, and I was drinking gallons of water to bloat myself. I exercised aggressively, and that became a game too. I would count how many sit-ups and press-ups I could do over the course of the day, and then strive to beat that score the following day.
Because I wasn’t formally diagnosed with an eating disorder, I’ve always dismissed that period of my life as just another episode of major depression. But now I’m older, and have read up on eating disorders, I can say that my psychiatrist was wrong. Furthermore, I’m rather outraged that he would even think of conducting his conversation with my mother in my presence.
What Are The Causes of Anorexia?
One of the main triggers of anorexia, is trauma. Young people who’ve experienced a traumatic experience, are more likely to develop an eating disorder. The reason for this, is the patient’s need to regain some control over their lives; because the traumatic event has left them feeling like they’ve had control taken away from them. The fundamental function that we all have autonomy of, is what we eat, when we eat it and how much we eat. No matter what life throws at us, we still have total control over that one aspect of our lives.
Another main trigger is low self esteem. Everywhere we go, we are surrounded by unrealistic expectations and examples of how our physical appearance “should” be. Ridiculously thin women stare out at us from the pages of magazines, skeletal models trundle down catwalks, fat shaming photos and videos are passed around on social media, while idiotic keyboard warriors guffaw and make offensive (and not very intelligent) jokes about the people in them. With all this ignorance around us, it’s no wonder young, impressionable people develop eating disorders.
The Failings of The Medical Field
Around a year ago, I received a letter from my eldest son’s school nurse. Because it was his last year of Primary School, he and his peers underwent a medical examination. Their height, weight and BMIs were measured and recorded. Then the results were sent to the parents. I was absolutely livid, when I received my son’s results.
In this letter, it said that based on my son’s BMI, he was considered to be overweight. The letter went on to patronisingly inform me that there are “resources” available locally to us, such as cookery classes and family exercise activities. Cheeky bastards.
My eldest son has played competitive football for 4 years. This means he attends football training once a week, and plays league games on Saturday mornings. At the time his medical examination took place, he was the captain of the school football team, and was also on the school rounders team. This meant that he trained 3 lunchtimes a week, and played competitive games twice a week after school. He was (and still is) a very active, sports orientated boy. He also has asthma, for which he is assessed annually by our practice nurse. She has never once raised any concerns with us regarding his weight or BMI.
As for the assumption that we are a family who leads an unhealthy lifestyle, what a crock of shit. My husband and I cook fresh meals daily for our children, and use only fresh ingredients in our food. Fast food is an occasional treat for our children, and we have a perpetually half-full fruit bowl on our dining room table. My youngest son also plays competitive football, in addition to never being seen outside without his beloved bike. Both my children are strong swimmers, and my Dad takes them to the local baths once a week.
My husband and I aren’t couch potatoes either. We both walk around 4 miles a day, and we only take healthy food with us to work. We both have medical conditions for which are monitored regularly, and our weight and BMI have never been a cause for concern to our doctors.
Anyway, back to the letter. I phoned the number on the letter, and spoke with the nurse. I told her how angry I was with the tone of the letter, and informed her of the above. Her response was “in some cases, very active children can measure high on the BMI chart due to their muscle density.” I asked her why this wasn’t taken into account when she took the readings, and her response was, “I have to follow the guidelines in my books.” So in other words, she isn’t allowed to apply her own common sense to her professional duties. Whatever happened to medical professionals being allowed to form their own opinions? Why does every person they assess have to be pigeon – holed into categories? Don’t they understand that everyone is different, and sometimes don’t conform to the generalisations in their textbooks?
This reminded me of my psychiatrist’s comments. I was displaying the behavioural signs of an eating disorder, yet because I didn’t fall into the right category on his chart, my symptoms were dismissed. When someone is already obsessed with their weight, the worst thing a doctor can tell them is they weigh too much.
And it’s this blatant callousness that provides the ideal breeding ground for weight issues in young people. Had my son seen the contents of that letter, would he have become self conscious? Would we have found ourselves sitting in an outpatients department, being told by a so called professional that he weighs too much to have an eating disorder? Would we have had to sit next to a hospital bed, while my severely malnourished son was being force fed through a tube? And for what? A poorly worded letter, written by some idiotic nurse and her bullshit textbooks?
I feel, and this is my opinion; that doctors are failing to detect eating disorders early enough, because of these stupid charts. They are presented with a patient who is displaying the early behavioural symptoms of an eating disorder, but because their weight hasn’t decreased to the point that they fall into the correct category, treatment is refused.
It’s difficult to say whether or not a full recovery is more likely, if doctors intervene before the patient’s weight is deemed to be at a dangerous level. But it does make me wonder.
The other thing that sticks in my craw about doctors, is they very seldom listen to their patients’ parents. Parents know their children better than anyone, and they know when something isn’t right. But because they don’t have a silly chart and a medical degree, doctors dismiss their opinions. My mother reeled off several alarming symptoms, yet my psychiatrist wouldn’t deviate from his chart. I didn’t belong in the right pigeon hole, so my symptoms weren’t taken seriously.
What’s The Solution?
Just like when I examined the issue of addiction, I have no one size fits all solution to anorexia. I can only apply my opinion to this, and make the following points:
- young people who’ve experienced trauma should be monitored closely by responsible adults, and the development of any unusual behaviours addressed in a timely manner
- the media should take more responsibility for the part they play in the development of eating disorders in their audience. Airbrushed photos should be banned, and models of all body weights and shapes should be used to promote products
- the medical profession should base their diagnoses on the bigger picture, and not just a small aspect of it
- district nurses should be allowed more autonomy to use their common sense to the medical assessments they carry out in schools. Again, their opinions should not be based on charts
- parents should be supported, and their opinions considered seriously by medical professionals
- the plus-size sections of clothes shops and online shops should be eradicated. This system promotes weight stigma and shame
- social media should monitor what’s being posted more stringently. All photos, statuses or articles which promote stigma and bullying should be removed, and the perpetrators banned.
I hope this post has been helpful, and I invite you to discuss your opinions, experiences and suggestions on this subject in the comments section.