An Apple a Day (7 page)

As well as birthdays, there's the annual Christmas extravaganza (which admittedly gets more fun as the little ones arrive). Sometimes I look around the kitchen table at my family, these people I love, handing out plates, helping each other to sticky toffee pudding or cheesecake, brandy-filled trifle or fruitcake, sharing forkfuls of meringue, squabbling over the last flapjack.

It's when we're all together that I feel most trapped by my illness. I want to join in, I want to share the fun and eat with them, but it's been so long. I've forgotten how. Gripping my mug
of black coffee more tightly, I feel distinctly not part of the family. (If they offer me a slice of cake I feel awkward, and if they don't bother to offer me any I feel angry.) I want to be a part of all that rowdy, pleasurable eating, but I can't.

This is when I feel like the death's head at the feast. It is hard to describe, this paralysis when faced with food in company: a low-fat slice of lemon drizzle cake, a small biscuit; anything, basically.

* * *

A few months ago, back in December, it was my sister Katie's birthday. Tom and I had been away for the weekend, reviewing hotels in Cornwall. He dropped me off at my flat around 3
PM
and I showered, changed, and cycled over to Camden for 4
PM
. We gathered in the living room over cups of tea, and Mum had made the most amazing cake: three layers of fluffy, buttery sponge, held together with fresh cream and raspberries, and slatherings of milk chocolate on top, dripping down the sides. It looked unbearably delicious: my mouth actually watered with yearning . . .

But of course I couldn't. We sang “Happy Birthday” to Katie and she blew out the candles and Mum doled out big slices of cake, while I just sat there feeling wretched. (And hungrier than usual, since it had been a difficult day food-wise and I couldn't face lunch.) Everyone had second helpings—even my two sisters and my mum, all of whom are slim.

Have you ever tried to encourage someone with an eating disorder to eat a small slice of chocolate cake, just to celebrate their own birthday, say? It's not stubbornness: they literally cannot do it. Can you imagine not being able to relax enough to take part in your own birthday party? A tiny bite of cake? I can't do it.

Cake aside, you can probably see that my family matters a lot to me. And that's a massive part of the motivation to beat anorexia.
I'm sick of putting them through this, sick of seeing their worried glances when I dare to wear a T-shirt . . . Because I know it's still not right, the way I look. At Katie's birthday, for example, I'd worn a new Oasis top that Tom had bought me in Cornwall—just a simple tee, sky blue, short capped sleeves. Alice and Mum exchanged a glance at one point, a glance I know too well, and I got a glimpse of myself in the large antique mirror opposite. As I laughed and gesticulated with my family, my hands looked like huge flapping things on the end of scarecrow-thin arms.

I want to start my own family, and I want to make it up to the family I already have. Anorexia has haunted their lives for too long.

Chapter 4

The Personal is Political

S
o, if “coming out” about my eating disorder was scary, if I'd worked for so long to keep it hidden, why on Earth would I choose to write about it in a national newspaper? I know that a lot of people think I'm crazy. No one was holding a gun to my head; no one was forcing me to do it. Or why not publish it anonymously? Curiously enough, this only occurs to me now: at the time I didn't even consider using a different name.

Something must have driven me, but I don't know what it was. Is everyone confessional these days; are we all compelled to spill our guts? An idea is planted and begins to grow, and then takes on a life of its own. Even as I was writing that first article for
The Times
, a few months before the weekly column began, I wasn't sure I'd actually publish it. Imagine telling the world, “I'm an alcoholic,” “I'm impotent,” “I binge-eat”—whatever your secret problem might be. It makes you feel horribly exposed. And one thing's for sure—coming out isn't as liberating as they tell you.

Far from it being cathartic, I found the whole process pretty disorienting. But this is a health crisis that matters on a larger scale. Like they say, the personal is political—and nowhere is this truer than with women and their weight. Yes, I was tired of anorexia, but I was also angry; I wanted to raise the issue of eating disorders and get it onto the public agenda (however modestly).
Of course it was my personal manifesto for recovery—a way of forcing my own hand—but that wasn't the only reason I wrote it. In some ways I'd have been happy to keep it between me, my family, and my psychiatrist, but I spoke out because I believe this is a much wider problem.

* * *

For too long, anorexia has been dismissed as a silly female hangup, or something that affects only teenage girls: the quest for the perfect figure. But it isn't a lifestyle choice, it's a killer. The facts are bleak. Anorexia has a higher mortality rate than any other mental illness: up to 20 percent of sufferers will die, either from medical complications or suicide. Even if you don't die, it can wreck your bones and your fertility. For so-called “recovering” anorexics, the relapse rate is high. The U.K.'s leading eating disorders association, Beat, estimates that around 46 percent of anorexic patients go on to recover fully, with 33 percent improving, and another 20 percent remaining chronically ill. A less than 50 percent recovery rate? That's a shocking outcome compared to other conditions and their modern-day treatments. And as to 46 percent recovering “fully”—really? From my own experience, and having talked to many former anorexics, I believe you never completely get over anorexia. It's a deep scar, a mindset that stays with you for life, no matter how “normally” you learn to eat, no matter how well you learn to live with it.

And yet it's still not a public health priority. The “size zero debate” isn't really a debate at all. Compared to illnesses such as lung cancer or heart disease, eating disorders rarely figure on the political agenda. (The reason I mention these conditions is that they too may appear to be self-inflicted in some way, or the “fault” of the sufferer, like anorexia.) Where is the funding for
research, where are the health initiatives? Why, when we know that psychological therapies can be of real benefit, are patients with eating disorders left for many months on waiting lists before they can get help?

Because it doesn't matter enough. The only recent intervention I can recall, at policy level, is the politician Lynne Featherstone's comments about curvy women in the TV series
Mad Men
. It's still on the BBC website.

Cue many inches of newsprint analyzing Christina Hendricks's shape—is she size 14, size 16?—and her generous bosom, reportedly GG. Of course the media love this kind of sound bite—they show some close-ups of Hendricks's cleavage and get another opportunity to pass judgment on women's bodies, but one might have hoped for more from a politician. Featherstone's pejorative reference to “skinny” women and her celebration of “curvy” role models is reductive, simplistic. It's precisely this kind of tactless language that, however unintentionally, fuels women's anxieties and insecurities about their bodies (as online readers of this story pointed out).

And as for saying, “her curves are fabulous”—it's hardly a serious way to address a health crisis, is it?

On the rare occasions that eating disorders
are
mentioned in the media, they are linked to a tragic death—usually a teenage girl—
or a female celebrity whom the trashy magazines have decided is getting too thin (after previously vilifying her for being too fat). But having a specific body shape—be it “curvy” or “skinny”—is not the same as having a mental illness. When eating disorders are discussed in public, it's often assumed that women are starving themselves because they want to look like supermodels. But anorexia is about much more than what body shape happens to be in vogue with fashion editors or designers (whose sample sizes are mostly unwearable by all but prepubescent girls). Many catwalk models look quite bizarre in real life, freakishly tall and thin—and that's not why most anorexics are starving themselves.

No, anorexia is more serious than that, and the true extent of the problem will never be known. While the terms “epidemic” and “silent killer” are thrown around too carelessly by the media, the fact is that we don't have accurate medical data because eating disorders
are
shameful and silent and often invisible. It's in the nature of the disease to remain hidden—particularly with bulimia or binge-eating, where sufferers may appear to eat normally in public, and often maintain a normal body weight.

Figures from the National Institute for Health and Clinical Excellence (NICE) (usually taken to be the most accurate) suggest that 1.6 million people in the U.K. are affected by an eating disorder. It is estimated that 10 percent have anorexia, 40 percent have bulimia, and the remainder fall into the category of ED-NOS (Eating Disorder Not Otherwise Specified), which includes binge-eating disorder.

However, these figures are based on the Department of Health's Hospital Episode Statistics, so they leave out the unreported cases where sufferers are not receiving professional help or have not been diagnosed. And even the official research isn't consistent: an NHS study in 2007 (the Adult Psychiatric Morbidity Survey) showed that up to 6.4 percent of adults displayed signs of an
eating disorder. I recently read an article in which it was claimed that “75 percent of all American women endorse some unhealthy thoughts, feelings or behaviors related to food or their bodies” (“Seventy-five percent of Women Have Disordered Eating,”
PsychCentral.com
, 23 April 2008). Seventy-five percent sounds high, but it depends on the definition of “disordered eating” (and it may not be far wrong when you consider the obesity crisis in the U.S.).

Whatever the true figures, eating disorders are life-threatening conditions. And they're affecting women disproportionately: of the 1.6 million sufferers estimated by NICE, only 11 percent are male. Since I started writing my
Times
column, I've been amazed how many women have admitted their own problems with emotional eating: that they use food as a way of rewarding or punishing themselves, that they're ravenous all the time, that they diet constantly and break their diets and have low self-esteem. I know them, you know them—you may well be one of them yourself. Not skeletal, not dying, maybe not even that thin. Anorexics and bulimics and overeaters and many others, whatever their actual weight, have this in common: a sense of shame about their appetite, a feeling of being out of control around food—anxiety about eating, guilt around every bite.

Most of these women don't appear on the official statistics. They're not hospital patients, they're “normal.” I know I hid my anorexia from myself, from those closest to me, for as long as I could: it was only the radical weight loss that forced me to stop denying it. I can only imagine how much harder it must be to ask for help when you're frantically overeating in private, already filled with shame, or bingeing and then vomiting.

I don't want to tar all women with the same brush. I don't want to generalize from women just dieting to those like me with a serious mental illness: I do understand that wanting to drop
a dress size isn't the same as anorexia. In fact I wish it hadn't been necessary to raise the issue at all, but the situation is getting worse, not better: many of us experience body hatred (or mild dislike) every day. Images of beauty are becoming more idealized and bizarre; some of our most famous female celebrities look like Barbie dolls. The routine airbrushing of models and actresses in magazines gives boys and men a wholly distorted view of the female body as slim with huge breasts, perfectly toned and tanned, smooth and flawless.

I'm no more or less susceptible than any other woman. In terms of withstanding media pressure I'd say I'm quite robust: I know how to Photoshop an image and I'm pretty savvy about the artifice behind it all. I don't bother reading gossip magazines (unless I'm in a supermarket queue or at the hairdresser) and I've never aspired to look like those celebrities, all hair extensions and laser-whitened teeth. Sure, I shave my legs and I pluck my eyebrows and I wear makeup and perfume and deodorant. But I can't escape the madness around me, the impossible demands being put on women, to be thin, sexy, fertile, beautiful.

We're surrounded by these unrealistic images in magazines, on television and cinema screens. The perma-tans, the hairless limbs (why have women starting waxing their arms?) and wrinkle-free foreheads. Surely I'm not the only one who scans through interviews with well-known women to check their ages, who wonders how they managed to bear children, or whether they ever eat. Why do I do that?

In a much-reported interview in 2006 to launch her beachwear line, the celebrity Elizabeth Hurley revealed that she ate just one meal and precisely six raisins a day in order to keep her figure slim enough for her signature skintight white jeans (she owns over thirty pairs). To be counting out raisins in your early forties strikes me as slightly sad, but who am I to judge?