When Treatment Makes You Sick: The Eating Disorder Clinic

Eight years after beginning ‘treatment’ for an ‘eating disorder’, I was eating worse than ever. Yet three years after quitting that ‘treatment’, food is a pleasure, not a problem. This is curious, isn’t it?

I entered ‘treatment’ willingly, because I was desperate to feel better. I had spent most of my teens either not eating or overeating, and I had had enough. When I found myself referred to a psychologist at 17 because I had trouble writing essays, I felt condemned to confess. I’d been hiding the truth, like a criminal against my own health. I didn’t want to be an ill person, a disordered person, a patient. Who in their right mind does? Yet I kept reading online that resisting help proves an ‘eating disorder’. Well, I wasn’t going to deceive myself like those other girls, who couldn’t own up to their crime. I was smart enough to see that turning myself in was the sensible thing to do.

Heart in mouth, I told the psychologist, “I think I have an eating disorder”.

He stood up slowly, walked over to his bookcase, and pulled out a thick, bound book, which I now know was the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. He looked in the index, then flipped to the front.

“Refusal to maintain body weight at a normal weight,” he read out. “Is that you?”

This had taken a bizarre turn. I was affronted. I’d summoned up all the courage I had, and he was questioning me, using some kind of encyclopaedia? Steve Gantz said that the act of diagnosis is a breakdown in relations between two human beings. I was both the diagnoser and the diagnosed, and the psychologist certainly wasn’t relating. He sent me to the therapist upstairs who dealt with eating disorders. She gave me a faded sheet of paper that described what a ‘normal eating pattern’ looked like (three meals and two snacks, never more than three hours apart, apparently) and muttered something about my mother probably interfering too much.

But I’d started doing my own reading. I ordered all I could find about ‘eating disorders’ from Amazon. The Golden Cage by Hilde Bruch; The Anorexic Experience by Marilyn Lawrence; Anorexia: The Wish to Change by A.H.Crisp et al.; Getting Better Bit(e) by Bit(e) by Ulrike Schmidt and Janet Treasure. Little did I know these were psychiatric, not scientific, texts, and that the high mortality rates they kept repeating (anorexia is the deadliest ‘psychiatric disorder’, apparently) might signal the hopelessness of the ‘treatment’, not the imperative to submit to intervention immediately.

I saw myself in their picture of a typical girl who has trouble with food: a late developer, high-achiever, compliant and cooperative. ‘Delusions of grandeur’ was another trait listed. My best friend and I had spent our childhoods inventing stories, in most of which we were queens. At 17, diagnosing myself, my imagination was more evidence that I had an ‘eating disorder’.

So I set out to become the opposite of everything those books described. I decided to lose my virginity. I did, to a stranger I never saw again. The day afterwards, I felt proud I could strike ‘sexually immature’ off my record. I tried to stop dreaming of what I could become (delusional) and tried to stop thinking (over-intellectualising). I took a gap year and travelled, alone, to the other side of the world. This would help me gain independence, which apparently I lacked. I tried so hard to be an adult, because I had read in these books that fear of growing up characterises people with ‘eating disorders’. My year abroad was a disaster. Putting myself in situations just because they were ‘adult’, yet unable to protect myself, I was raped. I thought it was my fault. I told no one, carried on, and came home broken.

Through what I now see as huge strength (though In Treatment, it was cast as the muddle of my life before ‘help’), I tried to forget the sinking feeling in my stomach, and pick up my life again. I started university. I worked abroad, and went on holidays with friends. But in quiet moments, I felt bad, contaminated.

I read Affluenza by Oliver James. The traits that he said determine a happy life—authenticity, playfulness, vivaciousness—did I have them? One of the chapters focused on a teenage girl with an ‘eating disorder’. In his pitiful description of how her drive to achieve had made her ‘ill’, I saw myself. Shit. I needed a professional cure, like James recommended. I needed help.

Now, one of the biggest aims I have is to make it possible for a 20-year-old in distress, looking for help, not to find psychiatric treatment as the default. It was 2009. The critical psychiatry movement was decades old. Yet as a young woman, steeped in the media, I had never come across the idea that characterising unhappy behaviour as ‘mental illness’ has no scientific foundation whatsoever.  I had had an au pair from when I was five to 11, who had been training as a psychiatrist. She was the first person my mother called when I said I needed help. Of course, she referred me to a psychiatric clinic. It was the Way, the Truth, the Light.

After a dodgy experience with a psychologist (written about here), I went to an assessment at a prestigious London clinic. I told the doctor about my trouble eating, my anxiety, my depression.

“Well, the depression will be because of your low blood sugar,” she said.

I felt proud that I was doing what she wanted, making it clear I knew I had an ‘eating disorder’. She wasn’t going to have to fight me to accept it, like those other dumb girls.

She sent me to the clinic’s in-house nutritionist. In 30 minutes, the lady drew up a daily eating plan. I was to follow it at all costs. Breakfast was a bowl of cereal followed by two slices of toast. Lunch was a sandwich. I was to have a cereal bar at 4pm. Dinner was meat, rice and veg. Three times a week, I could have dessert. A bedtime snack (25-30g of nuts) was recommended. Alcohol was allowed only in very limited quantities because it “can increase the risk that you will binge”, according to the booklet the nutritionist gave me, Working Towards Healthy Eating by Kate Trotter, produced by the NHS South London and Maudsley Trust.

By this point, I had moved out of my university halls and was living with my mother. It might be easier if I let my mother serve my food, the nutritionist said. That way, I’d be less likely to take too little or too much. Skipping snacks, I was told, also increased the risk of bingeing, because it could lead to my blood sugar falling too low. (In Treatment, low blood sugar precipitates bingeing.) The clinic inculcated such terror in me about low blood sugar that when I went on holiday with friends, I crammed my suitcase with muesli bars. An 11pm supper under the southern French sky became A Problem, because the eating plan had a hard time accounting for spontaneity, chaos and joy.

I learnt the gram weights of ‘typical servings’ of bread, pasta, meat, fish and fat. I took pride in buying packaged foods I hadn’t eaten for years. A self-force-feeding began. I filled myself with things that repulsed me, in the name of Health. I deliberately chose things I thought were gross, like white supermarket baguettes stuffed with egg mayo. Eating them was proof I was overcoming my ascetic fussiness about food.

At the time, my older brother was rejecting the medical model’s approach to psoriasis (lifelong steroids) and curing his skin through nutrition. He was making organic meals of vegetables, grains and fish. No gluten, no dairy, no inflammatory foods.

The clinic was teaching me that Restricting was bad. Yet here my brother was, delighting in restriction, evangelising about how particular foods were helping him. He was Dangerous, I decided. He might reawaken my Old Beliefs about some foods being bad. To be healthy, I had to eat pies and cake. I couldn’t possibly have salad for lunch.

“To keep your blood sugar steady, you need to include starchy food most times you eat,” the clinic’s booklet said.

I joined my brother for lunch in an award-winning vegan restaurant. He ordered lots of interesting vegetable dishes. I looked for the starchiest thing on the menu, which was mushroom pasta. I took the clinic at its word.

I learnt to seek the opposite of what I wanted. I learnt to deprive myself of pleasure, more than I ever had before. I did this because I believed Health would be the result.

“You cannot try to get your food intake right by relying on your instincts,” write A.H. Crisp et al. in their self-help book The Wish to Change. “You need to take food seriously in a new way. You need to eat very regularly, and rather repetitively. It is for this reason that we offer rather concrete advice in the Dietary Plans that follow. Sadly, it will be a while before food can again be simply enjoyable.”

The Rules had to come first. If I messed up, it was my fault for not following them.

“To prevent hunger and the risk of overeating, you need to eat just the amount of food that your body needs, as often as it needs it,” said the clinic’s booklet.

“Eating the right foods, in the right amounts, at the right times, can be a real help in gaining some control over chaotic eating. You will probably need to begin by eating at least every 2-3 hours or so.”

I was not to think of good foods or bad foods anymore—that was disordered. But I also had to eat the right food, in the right amount, at the right time. The Rules were structurally incoherent.

Every further expression of feeling through eating too much or too little became further proof that only the Rules could save me from myself. I didn’t dare not eat when I didn’t feel like eating, because this was sure to make me binge later. Any diversion from my task of maintaining steady blood sugar put me at risk of self-punishment later in the day. For all those years, my stomach was never empty. Biologists now say that the gut’s microbiome fares much better with at least a 12-hour overnight gap between meals, and that fasting can be hugely beneficial. If I had so much as uttered the word “fast” in that clinic, I would have been told I would cause myself harm. I would have been treated as a renegade.

“Your eating disorder will remain your Achilles’ Heel for the rest of your life, and it will be there to trip you up when you least expect it,” Professors Treasure and Schmidt write in Getting Better Bit(e) by Bit(e).

Now, I feel rage at such claptrap finding its way into print, let alone into the heads of people in pain. But at the time, I think their statement was a significant contributor to my depression. I was being told I effectively had a terminal illness—one present until I die—that only constant, conscious vigilance could keep at bay. I am astonished I had the strength to get up and carry on my day, being indoctrinated with such fictitious nihilism.

Managing this eating plan became a full-time occupation. I couldn’t just turn up to a social event and eat like anyone else. I had to ask how many courses were coming, find the starch, ensure I got enough. Failing to do this would result in a ‘trip up’.

Habits that started In Treatment got more entrenched. I had the same heavy breakfast for years, even on baking hot summer days. Whenever I felt hungry, I became scared I would overeat. I only let myself eat at mealtimes and snacktimes. Therefore, at every meal, I had to fill myself up with just the ‘right amount’ to carry me through to the next. Unbidden offers of food from others, let alone someone actually putting extra on my plate, freaked me out. Food was regimented, a threat, an enemy at the gates. If I couldn’t make a meal fit into the composition prescribed by the eating plan (starch, protein, fat, veg)—if a friend served a fillet of fish with salad, for example, no starch to be seen—I was unable to function. I didn’t know who or where I was. I had deviated from the eating plan, which was the only thing that defined my identity. Outside it, I was unfit to speak. I could never effectively explain in the clinic (or more accurately, I was never heard explaining) the phenomenon of being out of sorts, of leaving myself behind, whenever the eating plan had to be left behind.

“It’s like my mind shuts down,” I told my therapist. “Then I feel scared and anxious.”

“Have you tried breathing techniques?” she asked.

Of course, there were ‘trip ups’ (‘lapses’) all the time, when I couldn’t stop eating. In the early years, I told my therapist about them. It was proof that I needed her, justification of my identity as a patient with an ‘eating disorder’. Together, we worked out that if I got my behaviour a little more accurate next time—if I challenged my thoughts harder, or hadn’t let myself be alone that evening, or had eaten more at the previous meal—then they wouldn’t have happened.

“Each time you feel inappropriately upset or act against your own interest, look for your thinking errors—thoughts that fuel your upset,” write Professors Treasure and Schmidt.

The process with my therapist of revising these “errors”, of honing previous behaviour into the perfect shape, took up much of our sessions. Lucky me that I had the (£135-an-hour) help of someone so soothing! Turning back time really is an extraordinary exercise in relief.

As one year seeing her became two became five, I told my therapist less and less about the times I overate. It was embarrassing; shouldn’t I be better by now? Our sessions became places where I took every decision I had to make. I had been so stripped of conviction in my instincts and ability to succeed that I needed her guidance on any turn I took. I tried to show her, all the time, that I was organizing my life according to Health. I never told her the extent of the work it took to achieve a day of calm—the daily hour in the swimming pool, the exact quantity of oats in my breakfast, the handful of lunch options from Pret, the dwindling range of outfits I could wear.

My wardrobe! Another casualty of the clinic. When I first arrived for ‘treatment’ at 21, I loved clothes. I had lots. Some were pretty, some eccentric, some revealing. My arms were ringed with bangles. I always wore earrings. But as the clinic’s prescribed regime clamped over my days—as I learnt to write out in the evening exactly how I planned to spend the next day—the impulse that one feels, when dressing, to choose this pair of earrings over that; the long dress over the short; the green scarf over the pink, began to feel like a dangerous expression of agency that might derail my incipient will to submit. It was all frivolous, anyway. I’d clung onto making myself beautiful as a life raft out of trauma. Now I had adopted the identity of someone with an ‘eating disorder’, any action that had delayed the adoption of that identity—any solace other than psychiatric treatment—was an enemy of Health. The pleasure I got from putting outfits together, from caressing lashes with mascara, could be dispatched with. I didn’t need other consolations. I had Treatment.

For the first three years of therapy, I lived in a grey hoodie and leggings. I stopped wearing jewellery. It sat on my dresser, in a haunting, glittery pile. When I got a job and had to wear formal clothes, I chose knee-length skirts and loose shirts. I made the minimum effort possible. I didn’t know who I was when I looked beautiful. It reminded me of Before Treatment, and I had learnt in the clinic that that had been a time of ignorance, of mess, of a mistaken faith in my own ability to help myself. I had been a pretty teenager. But by 24, I had bad skin (it had broken out weeks after starting Prozac), I couldn’t bear to wear make-up, and it hurt when people said, “you look nice”. Deep down, I knew my looks were going to waste. But I had to ignore that wistfulness in the name of Health, the same way I had to ignore the salads my brother offered me, and choose the starchy option instead; the same way I had to shrink any dream of being an author, and look for an easy job, because I had learnt in the clinic that I couldn’t cope with striving and stress.

My twenties dragged on. I spent my days on the run from anxiety, with no idea how to handle any difficult emotion apart from (ironically, after years In Treatment) eating or exercising. I had been on antidepressants since I was 20. I believe they caused the constant restlessness I could never shake, but that’s for another chapter. At 27, I took a job I didn’t want, encouraged by my therapist, and continued seeing a boyfriend I didn’t want, encouraged by my therapist. I have written elsewhere about what happened next, but in summary: I got accidentally pregnant, had an abortion, found myself in a coercive relationship, and spent a year wanting to die. It became clear my therapist had no idea what to do. All she could suggest were more antidepressants, and going home to my mother. I remembered first meeting her all those years ago. I had been unhappy, traumatized, convinced of my own faultiness. But I had never, ever wanted to die. At 20, when my mother asked me if I had ever thought about ending it, I was shocked. Of course not! I was unhappy, but I knew in my bones there must be a way out. I was steeped in literature, for god’s sake—I knew the depths of melancholy that had been written about for centuries. I had company in despair. Yet after eight years In Treatment, hope was well and truly dead.

How could so many years of ‘help’, leaving such a great dent in my father’s bank account, have given me so little insight into myself that I had created this hellish existence? It was my doing, after all—the boyfriend I hated, the treadmill of kitchen-swimming-pool-clinic, the compulsion to follow a career I didn’t want. I felt powerless to change any of it. I realised I knew nothing about myself.

Everything I was told about my eating in that clinic was fiction. Nothing they prescribed ‘fixed’ it. Until it was understood as a meaningful expression of feelings I couldn’t stand, and not behaviours that were the result of faulty thinking patterns, I would continue to express pain with food. In psychoanalysis, I dropped the absurd charade of measures that the clinic told me would ‘restore healthy eating’. I began to ignore mealtimes and ‘serving sizes’, the compulsion to include starch, the planning and preparation and regular snacks. I ate purely for pleasure. I fasted, without fear of collapsing into overeating. I stopped buying muesli bars, and started making those heaps of greens that I had turned down from my brother. I got drunk at home, alone, for the first time, and the second time, and the third time, and followed it up with exquisite pastas and steaks and ice cream, never overeating like the clinic told me would happen. I let myself go hungry, to remember what it felt like. I learnt not to eat if I didn’t feel like eating. I learnt the world doesn’t cave in if I skip lunch, which sometimes happens. I also learnt that two donuts in a row isn’t a problem.

I got to this point with the help of a psychoanalyst, who spoke the phrase “eating disorder” as though it were a dirty piece of laundry, to be cast as far away as possible. He never castigated me for not eating. He seemed bemused that I would force myself to have lunch when I didn’t want to, just because it was 1 o’clock. I could tell him about the joys of drinking wine, without the possibility he would pathologize it, or warn I was adding alcoholism to the mix. The whole boring sludge of obligation and sickness that once surrounded food has gone. It evaporated in the company of someone who saw the diagnosis of ‘eating disorder’ for the fabrication it is.

In truth, I don’t know what the hell to do now. Of course I wish I had never endured the years of brainwashing and lies in that clinic. But I had the good fortune to get out. I don’t know how to help others being told their ‘eating disorder’ is a lifelong sentence that requires constant management. I have my voice, and I will use it. Too many bibles about ‘eating disorders’ claim to be fact. It’s time they were revealed as fiction.