Wandering from the bitterly cold winter air into the unbearable warmth of a motherly friends’ cozy home; dizzy, weak and genuinely exhausted. Awkwardly crouching down in the dimly-lit entrance of the one-bed flat and untying the irritatingly unsymmetrical laces of the now scuffed up Doctor Martins.
The uncanny pungent and sickly-sweet scent of melted cheese overlaying the undeniable smokiness of crispy bacon attacks the very essence of my sense of smell. Gagging, I pull my deliberately oversized Marilyn Manson T-shirt up over my nose, desperately trying to mask the smell of a once-loved meal.
“You alright chick? I’ve made some pasta bake, have you eaten, or do you want some?” The typically East End accent of a friend, flows from the brightly-lit kitchen that screams homeliness. ‘No, no, no, no, no,’ scream the voices inside my now spiralling mind, as it tries to reject all things food. ‘Please… just let me eat?’ I beg my mind, as the violent, sickening hunger intensifies. But trying to reason with the drill sergeant that is now residing within the mind, holds absolutely no substance at all.
The voices string together the very thoughts of obsessive self-loathing, that I had once worked so hard to ignore. The dreaded nagging voice of the eating disorder, that I’d once worked so hard to will-away. ‘Don’t you fucking dare even think about it. Look at you, weak and pathetic. Do you really want to eat? Go ahead, you’ll only throw-up afterward anyway,’ they echo in the darkness of the mind.The slowly-developing panic soon boils to the surface – dizzy, over-heated and pale cheeks become numb. My heart trying to pound its way out of my breathless chest, onto the cold, hard floor. Before the chance to respond to the figure pottering around in the warmth of the kitchen arises, my body hurtles itself into the complete darkness of the bathroom, desperately trying to remove the foreseen calories out of my already-starved system.
Exhausted. Sitting myself down, back up against the bathtub, knees pulled in and tears rolling down pasty cheeks, the door creeks open, and the familiar slim figure wanders in, sitting beside me in the complete darkness. Silence lingers for just a moment. “Chick…” she begins. “I beg you get some help ‘cos I’m not gonna watch you try’n to kill yourself with this shit again.” Shame, guilt, and defeat set in as I half-hardheartedly nodded in response. Those simple words – words of a now harsh concern – still linger somewhere within, though the voices hold it all, with my own mind by their side, seemingly powerless. Logical? Of course, it isn’t. Why would it be?
But that is exactly the problem with eating disorders – they are completely illogical and dangerous in all of their forms. Essentially, eating disorders take away the very essence of the individual sufferer. The light seems to fade, the personality changes, and the ability to function slowly deteriorates.
A sense of depressiveness, obsessiveness, and secretiveness seeps in too, with the eating disorder becoming their only friend, who they become bewilderingly dependent on. As such, it is almost impossible for the sufferer of an eating disorder to see that there their unhealthy relationship with food is problematic and potentially life-threatening.
However, it isn’t a secret now that many in the UK are falling ill to eating disorders, even they do so unwittingly. The rise in numbers of those affected by eating disorders, followed by the decrease in effective out-patient treatment, is becoming a concern that needs to be addressed.A report by the leading eating disorder charity, Beat, has estimated that around 725,000 people in the UK, are currently affected by anorexia nervosa, bulimia nervosa or body dysmorphia. Breaking down the report by Beat, it suggests that around 1 in every 250 women and 1 in every 2,000 men will experience anorexia nervosa, despite bulimia nervosa being three times more common. The same report also suggested that 90 per cent of those with a diagnosable eating disorder were women. However, the response to this was that women are more likely to attempt seeking help.
However, seeking help, or asking someone to seek help for such an isolating and secretive illness is dauntingly terrifying. For those with the disorder, it is almost as though they are being told to kill their only friend. It is asking them to will away the coping strategy that they themselves have grown into a love-hate relationship with. It is asking them to come to terms with addressing their disorder as a disorder. It is essentially asking those with an eating disorder, to decide to live and to live well.
For one university student, 22 year-old Kara O’Brian, her eating disorder began as a response to the idea of wanting a healthy lifestyle. “For me, it started when I was in college. I did most of my ‘partying’ in my early to mid-teens and become kind of bored with it. I was done with that scene and I wanted a healthy lifestyle, so I started watching what I ate and I started exercising probably more often than I should have,” Kara told Artefact.
“Other people started noticing that I was losing a lot of weight and complimenting me. It’s safe to say that I liked the compliments – it gave me a sense of positivity – something that I could be good at. Over time though, my personal list of ‘good foods’ got shorter and shorter, and my list of ‘bad’ foods just got longer and longer.”
“I would go for longer runs, spend more time at the gym, and as I lost more and more weight, I couldn’t stop myself from wanting to lose ‘just a few more pounds’. I was consumed by it, but I was never satisfied with my progress. I would bounce between two extremes – from severe restrictions where I would go for days without food, to bingeing and purging,” Kara explains.
“I became really ill with it, but I was too ashamed to ask for help. That’s the issue though. When you are stuck in these rigid rules that you know are illogical, and knowing that other people won’t understand, you just feel ashamed. But breaking the rigid rules that you’ve had for so long, makes you feel just as ashamed and just as guilty,” she said.
“Looking back on it now, there was a hell of a lot of internal stuff going on that I don’t think I knew how to deal with – like never feeling as though I was ‘good enough’. I went through a break-up and I never really dealt with that either and I think that’s why I began to compare myself to others. College is a chaotic time in general, too. I just didn’t feel in control of myself or what was happening. The [eating] disorder became my control, but in reality, it controlled me,” Kara concludes.For many people, an eating disorder resembles a sense of self-control, when all that around them seems so chaotic, and irreversible. For many, if they can control food so adequately, everything else feels as though it simply falls into place. However, this isn’t the case at all. Instead, many of those suffering from an eating disorder, are in dire need of support. While seeking help is the most difficult aspect for those suffering an eating disorder, it is only becoming increasingly difficult to access out-patient support for eating disorders.
This difficulty resides partially in the lack of funding for community mental health services, leaving many people with the prospect of little to no help at all. The complete lack of funding is also making it difficult for mental health professionals to provide appropriate care for in- and out-patients alike.
Out-patient eating disorder services have almost become a postcode lottery, leaving many to wait anxiously for their ticket number to be called. In some areas, community care is of a good quality, compared to some of the poorer areas of the UK. However, with such a lack of funding within the mental health sector, it is no surprise that there is no standardised care across the country and that those from poorer communities are suffering the most.
While funding is an issue, GPs are merely concerned about the body mass index (BMI), rather than the damage, and potential damage that an eating disorder may cause in the long term. Many people are turned away as they are not deemed unwell enough to be referred for the care in which they so badly need. It is often the case that people seeking help from their GP are sent away with no more than a diet sheet – something in which is of no use to someone with a progressive eating disorder.
This is just another typical narrative for many people suffering from a soul-destroying condition: “I knew my eating was becoming an issue and I didn’t want to go down that route, but I just did not know how the hell to get out of it,” 20 year-old Sam Johnston told Artefact.
“I went to the doctors and they weighed me, but my because my BMI was fine, he just basically told me that I was fine. He gave me some of these diet sheet things and prescribed me anti-depressants, even though I didn’t want them – I wanted the help. Because I wasn’t eating and throwing up after every meal that I did end up eating, the anti-depressants didn’t help at all, and my eating just spiralled downhill,” he said.
“It seemed like I was going around in circles – my depression feeding into the eating disorder and the eating disorder feeding into my depression. At home, things were very volatile, so I couldn’t even ask for their help,” Sam explains.
“When I used to self-harm, my parents would rather scream at me than try to help, so there was no way I could go to them with this. They are very much ‘just get on with it’ kind of people. I lost so much weight and they still didn’t even realise that I had an issue. I think feeling invisible and not really feeling that I belonged was what triggered the eating disorder. I felt so disassociated and disconnected from everyone and everything that in the end, I think I just wanted to feel,” he said.
“Eventually I had lost so much weight and my body was failing, that I ended up in hospital. I was too ill for out-patient care and spent six months in a unit. It helped to the extent that I simply ate, but the nagging voice in the back of my head is still disappointed in my choice to ‘comply’. I think that you can get better, but I don’t think it ever truly goes away,” Sam concludes.
Many people, like Sam, who have managed to find it within themselves to visit their GP with the hope that they will receive help, are often lost within the system and won’t be treated until their health is at risk. Being ignored by doctors is just adding to the number of people admitted to hospital because of a life-threatening eating disorder.
Data from the NHS Digital shows that hospital admissions in the year 2016-17 had reached an all-time high. NHS Digital shows that during this period, 13,885 people were admitted to hospital – a huge jump from the 7,260 in the year 2010-11.The increase of hospital admissions is a direct response to the inability to access community services locally. Doctors and campaigners have consistently warned that the lack of funding for community services will lead to a rise in longer waiting times and an increase in hospital admissions for those with life-threatening eating disorders. However, the attitudes of some GPs are partially to blame for the rise in hospital admissions.
Failing to refer patients for out-patient treatment as soon as they present themselves at their local GP practices is simply allowing the condition to worsen. Once referred, however, people can be waiting up to a year for an initial assessment – and by the time the initial assessment has taken place, an individual’s eating disorder may need hospital treatment anyway.
“It is clear that the system is simply not working, and it hasn’t been working for quite some time now,” explains one general practitioner, who specialised in mental health, and who didn’t wish to be named.
“We are in desperate need of funding to be reinvested into community services for those suffering [from eating disorders], but we are just not receiving the financial support. Without the funding, we simply cannot refer people to community services close to home, when they actually need the support,” they said.
“We are having no choice but to refer people further and further away from home, and sometimes this means that we have no choice but to refer patients for in-patient treatment. Some families have had no choice but to relocate to another community so that patients can access out-patient treatment, and that isn’t ideal for families who are leaving their friends, family, work, and school just to access treatment,” he explains.
“For those who can’t relocate, waiting lists can be as long as eight to twelve months. It is so frustrating to witness patients deteriorate and knowing that this deterioration could have been prevented. If it is frustrating for us, we can only assume how frustrated the patients must feel. We need to get a handle on this, but to do so, services need to improve,” he said.
“The way that we assess patients need to improve too if we are to truly help people. Of course, the first step lies with us as general practitioners. I’ve known many colleagues to hold-out on referrals, simply because a patients BMI is healthy. This is probably the most dangerous reasoning to not refer a patient to a service. Leaving a patient to deal with this issue on their own, reiterates in their mind that they are alone, and this can potentially have a negative impact on recovery,” he concludes.
However, the issue isn’t just with the lack of support for people within the community, but the way that hospital care is conducted too. There seems to be a consistent issue, where neither patient or parents are taught about the possibility of a relapse, nor are they taught about relapse prevention.
All too often a person will be admitted for treatment. Here they are force-fed, and once they are deemed healthy again, they are sent on their way. There is absolutely no transition between in-patient and out-patient care. They are simply discharged, with ineffective coping mechanisms and are expected to adequately function in the real world.
For the people who need the help in coping with their eating disorder, it isn’t appropriate to allow them to become so severely ill before treatment is even offered. With the number of people suffering from severe eating disorders and attempting to seek help – services need to be funded, developed and adapted, with inpatient care being the last resort.
Adequate government funding needs to be provided, so that there are appropriate and necessary resources, to help out-patients to fully recover. Funding also needs to be put in place for specialist training, so that community care can be most effective.
GPs, who are usually the first port-of-call, also need fully-funded, extensive training, not only in the field of eating disorders but in the broader field of mental health. Failure to provide this training means that at present, many more people are missing the opportunity to receive the help that they need. To simply send people who are suffering from an eating disorder out of the door with a sheet of paper in their hands, and telling them to ‘just eat’, isn’t adequate or justifiable at all.
Waiting time for out-patient treatment needs to be addressed too. Funding of staff training and supporting new practitioners could help reduce the time it takes for people with eating disorders to access the appropriate care. Reducing the time that people are waiting for out-patient care, could prevent patients from becoming severely ill.
This could also help to reduce hospital admissions. However, with in-patient care, there needs to be a space in which patients can be released from hospital and in which they are helped to fall back into society with ease, and without worry of a relapse later in life.
Despite the hardship of trying to access help, it is encouraging to see figures that show an increase of people attempting to make the first steps in trying to access help. It shows that, despite knowing that there is an uphill battle to be won, people are wanting to conquer their isolating and soul-destroying eating disorder.
It is a constant, uphill battle, but once the battle has been fought and won, the sense of achievement, conquest, hope, and self-belief are feelings to cling on too. Seeking out the help needed can only provide patients with the future that they so rightly deserve.
Featured Image by Matthias Ripp Via Flickr CC