I penned this a couple of months ago, and given the recent research into the economic impacts of eating disorders (conducted by PwC – more info here http://www.b-eat.co.uk/latest/602-the-costs-of-eating-disorders-social-health-and-economic-impacts: ) it seems topical. My underlying opinion is that mental health needs to ‘catch up’ with physical health when it comes to consideration and provision in the workplace. In other words, workplaces need to become more readily adaptable to allowing people with mental health issues to be able to work, in the same way that they adapt to physical health issues. Another important issue that this blog post touches on is the bias in research and treatment dedicated to helping young people compared to adults (specifically regarding eating disorders).
Living with anorexia is tough going. No surprises there. Simply staying alive is hard enough, and sometimes things get so bad that your existence (or subsistence) is whittled down to basic survival. In other words, you end up hospitalised and your life is put on hold whilst you’re given the treatment you need to keep you living, with all control taken away from you.
But what about if things don’t get quite that bad? What if you have to live in the real world, performing relatively normal everyday tasks, whilst juggling an eating disorder at the same time? I can tell you this is nothing short of torturous. No you’re not in a coma, but hell some days you wish you were, just so you didn’t have to try and ‘be normal’.
Being an adult with anorexia means you have to live every day twice, at the same time. You’re two different people at once. One person (you) is performing the basic tasks of life; holding down a job, maintaining a house, making and keeping relationships and friendships. Simultaneously the other person is pandering to the eating disorder’s every need; overexercising, being utterly preoccupied with planning every meal, fretting about social occasions, etc. etc. Years of experience have taught me that these two people cannot be merged. They just remain in battle, both fighting for domination in your body. And on top of there being a whole other person getting in the way of you performing everyday tasks, which obviously makes it difficult to concentrate any energy into them, the tasks are much harder to accomplish because you lack physical energy, mental capacity and physiological operation. Not only does an eating disorder get in the way, it also actively supresses your functioning.
I would never deny that living with an eating disorder whilst a child or teenager is difficult, but I feel that not enough recognition – or help – is out there when you are grown up. It seems to me that young people are seen as vulnerable and impressionable so a lot of resource is ploughed into preventing them developing eating disorders and/or treating them promptly. However adults are seen as not being in such a dangerous position; they’re able to ‘look after themselves’. I beg to differ. I have proved to myself and everyone around me that I am pretty rubbish at looking after myself; the person living the anorexic life usually has domination, rendering everyday tasks almost impossible. But I have to keep pushing through every gruelling day because I simply have no choice. I can’t give up work; where would my money come from? How would I pay rent? Going into hospital voluntarily as an inpatient has been an option for me for a long time; in fact my consultant has very much pushed the idea. But I don’t feel I can feasibly do this; the inpatient treatment offered at my local NHS eating disorders unit is an ‘all or nothing’ approach, involving 8 months of virtual imprisonment during which I would not be allowed out unsupervised, and visitors would only be welcome at certain times. After this I would enter a 6 month ‘rehab’ phase where I would be allowed to slowly integrate back into normal life, but would return to the unit to eat and sleep. Obviously I would have to give up my job for this, and my relationships – with my boyfriend and my family – would become incredibly tough, as contact with them would be regulated and minimal. I fully appreciate that inpatient treatment really suits some adults, but it has never seemed like a good option for me. And I imagine that for many adults, who have families to look after, the inpatient route to recovery seems even more impassable.
I only speak from my own experience and opinion here, but I feel that more research and development needs to be channelled into improving adult outpatient treatment. Also eating disorders (and other mental illnesses) need to be recognised as conditions for which workplaces must be accommodating in order for people to make full recovery. In the same way that a person diagnosed with cancer may need to attend regular appointments and perhaps take an extended period of time off work, or go part time for a while, these allowances need to be made for people suffering eating disorders.
Outpatient treatment requires commitment; it’s not simply a case of having a weekly appointment for an hour and spending the rest of the time living a normal life. You have to put serious hours into ‘recovery time’ – for example writing journals, making meal plans, simply sitting and collecting your thoughts. Doing this whilst still carrying the responsibilities of a full-time job is not ideal. I’ve been known to rush from a psychotherapy session, during which I’ve been in tears, straight into the office to conduct an important meeting. The danger here is that my brain was not fully engaged in either the therapy or the meeting. Many physical therapy sessions are widely recognised as being ‘gruelling’, and there would be no question that a whole day off would be permitted to attend and recuperate from the appointment. But the lines are more blurry when it comes to mental health appointments, and employees may need to conduct awkward conversations with line managers. Crucially this is where stigma rears its ugly head; most people would be far too terrified that their workplace would start to doubt their ability to continue in their job if they admit that they have a serious mental health problem that needs treating.
And so the adult anorexic has no choice but to limp along, living this surreal and exhausting double-life, trying to please society 100% of the time and anorexic thoughts 100% of the time.