'She cries at night telling me she's fat' - Mum on the pain of her teenager's eating disorder
Discovering that her daughter had an eating disorder turned one mother's idea of what it means to raise a happy child on its head
She cuts her pizza into tiny slices. It's homemade, generously covered in sauce and cheese. She lifts a slice, then drops it.
"I can't," she says. I am sitting right beside her at the kitchen table and I move in closer.
"Yes, you can, sweetheart," I say. "Yes, you can."
"It's disgusting!" She is pushing her plate away. She glares at me, eyes big in a bony face. Her hair is dry and her pale skin is tinged blue. "It's gross."
I move the plate back in front of her. I say the line I prepared. "This is the right thing for you to eat. And you can eat it."
She tries wheedling. "Please don't make me. Please, Mum. I'll have something else. I'll have toast."
She looks around for ideas. "I'll have milk, Mum. I swear I'll drink a glass." She reconsiders. "Half a glass, I swear."
"This is your meal, sweetheart," I say calmly. My heart is pumping but I force myself not to show a reaction. Her eating disorder is fighting me, manipulating me. I must ignore it. It has damaged my daughter's brain. Behind it lies my own sweet, troubled kid who wants to be well. I know this. I am firm. "Everything will be fine. I'm here and I'm going to help you."
She pushes back from the table and runs from the room, slamming the door and running upstairs.
I give myself 30 seconds. Then I walk slowly upstairs.
I walk in and she looks at me defiantly. "Come downstairs now, please," I say. We are four weeks into this. So far I have not lost my temper, raised my voice or given in (this perfect record will not last). So far, she has eventually eaten at least part of whatever meal that's in front of her. Often she has eaten it all. Eventually, on this night, she eats half.
We are making up, slowly, for six months in which she skipped multiple meals, and I failed to notice. For months in which she also exercised aggressively, lied repeatedly and - with the discipline of an Olympic athlete - controlled every morsel that passed her lips. And by doing all of that, she managed to cope with the stresses that were plaguing her in a new school.
"Is it anorexia?" I demand of the person who answers the phone at the eating-disorder clinic, wanting a word I can hang this on, something definite.
"It sounds like she is having considerable distress, yes," he says. On a city street I wail aloud at the phone. How did I miss this? People stare.
And so in a bid to rescue her from a mental disorder which (some calculate) claims the lives of one in 10 of those who fall prey to it, all control is removed from my daughter about what she consumes.
I have embraced the Maudsley method, about which there are several well-regarded and accessible books. The premise is that most people with eating disorders can't choose to recover until they are nourished adequately and families can help. My gut tells me my daughter will - deep down - trust her parents.
She cries at night, plucking at her body, telling me she feels fat. "Fat's not a feeling," I say, which is something the therapist said. I have learned not to engage, not to give the eating disorder more power. My precious adolescent baby is ill. A self-destructive monster has taken her over. I am a tiger and her eating disorder is my prey.
She gets breakfast, lunch and dinner each day, plus three highly calorific snacks. Lots of protein. Decent carbs. High-calorie drinks to beef it all up. Her breakfast is a giant bowl of cereal, twice what I would consume normally. We set the alarm an hour early in the morning so she can get through it.
And she does get through it. It is amazing to see. The dietitian tells us this is the minimum our child needs to start to build herself back up. We take this seriously.
The experts tell us to keep her away from all food preparation or she will try to control ingredients. We are keeping her company for all meals, sometimes physically squeezing in beside her so she can feel our support. The eating disorder hates us for it.
She yells at us when we tell her she can no longer be on the swimming team. We baulked when this was first recommended by the therapist. We are doing a lot of therapy. Group sessions. Individual sessions. We are grateful that she is young enough not to refuse any of this, though at the start, she barely engages.
"Oh, but she loves swimming," I said. "She's really good at it and she has friends there."
The therapist is unmoved. She has seen it all. Our daughter may well be good at lots of things. This is fairly typical of people with eating disorders. They are often high achievers. They are good at self-control. It won't stop them being sad, or save them from malnutrition.
Confronting an eating disorder - we come to realise - means adopting new ways of thinking about measuring success. "You need to prioritise," the therapist says firmly. "What matters more - that she swims or that she gets better?"
We take her out of swimming. And dance. Tennis. She doesn't need to expend calories. Even the school chess club she joined at school ends, because it happens at lunchtime and that means she doesn't get time to eat her lunch. Instead she eats lunch under light supervision. Left to her own devices, we assume lunch would go right in the bin.
Our thinking is that, if this arrangement stops working, we will feed her in the car outside the school every day. I have worked out how this can be done. Thankfully, we never have to go quite this far. She eats her lunch. She is resigned. We are unrelenting. We are lucky she is so young and still remembers what obedience means.
There is constant surveillance; there is no break from it. In the early weeks and months, 'refeeding' our daughter is awful for all concerned. The books say not to panic over any one skipped meal but I do. I am obsessed with seeing flesh on those bones. It seems to take so long for any change to come.
I have to cope with another fact that's even harder to absorb: that food is not the problem here. It is the underlying mental distress that we most urgently need to help our daughter with. Restoring her weight is a small part of the battle.
Before, I knew nothing about eating disorders. I thought people chose not to eat because they wanted to be thin and then lost the run of themselves. There is so much more to it than this. In therapy, we learn there is hope. This is incredible to know. With the right intervention, this thing can be tackled. We learn not to talk so much about 'eating disorders' but 'eating distress'. Because a refusal to nourish one's body reflects a very serious distress of the mind. Like the more obvious forms of self-harm, it reflects an acute absence of self-esteem, an internal anguish.
Outwardly, a person suffering from eating distress can function for a very long time. They may be doing well at school and performing well at sports. But many share what we might colloquially call a very 'thin skin'. They are sensitive. They absorb slights and criticisms far more deeply than average. They bear wounds inflicted over years and they find it impossible to express their own anxiety and fear. They experience eating distress as a malicious and highly critical inner voice that tells them over and over again they are worthless, pointless and fat.
They are only coping at all with daily life, we discover, because they are exorcising their demons by depriving their bodies of nutrition. Once they lose their crutch- their ability to deprive themselves - all the underlying anxiety and fear comes to the surface. And the only way to cope with that is to offer maximum reassurance and support. And get professional help.
It has been more than a year since the night of the pizza. Meals are no longer a battleground. It took about nine months for us to ease supervision. Her mood improves slowly. She appears relaxed.
Therapy continues. On average, I am told, a person recovers from eating distress in two to seven years. There's no quick fix. We intervened early and comprehensively, and that was lucky. We have met parents who are still mired in crisis. We have met parents who are in total despair.
The broader lesson I have personally learned is that our greatest gift to our children would be to raise them free from fear, free to be themselves, just as they are.
I believe we need more balance in our approach to kids. And that we sometimes push the wrong kids. Some cope fine. Others bottle up a world of stress. We want them to be too perfect, too together, too successful. We want 11 A1s in the Junior Cert and a heap of friends, to boot.
To me, now, none of it feels like it matters much. That may change. I am recovering too.
Of course there's nothing wrong with success of any kind. It's great. But it can't come at the expense of a sense of self. It cannot leave our kids hollowed out, sometimes literally, because they have given so much at the surface level of life that they don't know who they are.
So for me, if a child starts skipping breakfast, binning her lunch or overexercising, the biggest question is not, 'Is this child too thin?' The question is, 'Is the child ill at ease; is the child truly comfortable in his or her own skin?'
If your gut tells you there's a problem, take action. Right now.
EATING DISORDERS RESOURCES FOR PARENTS
■ YOUR FAMILY GP IS The first port of call They can check weight (make sure they do this 'blind', as your child does not need to know) and then recommend your next step.
■ LOCATE Eating disorder therapIES There are several specialist units, some attached to hospitals. Ring them all. Visit them. Most will have waiting lists. You can find a list on the bodywhys.ie website, which also covers GPs. Individual psychiatrists and counsellors will also specialise in eating disorders. Ring anyone you can find and ask what they might do.
■ RESEARCH Dietitians Some eating disorder units employ qualified dietitians and some don't. A dietitian can help you work out what calorie intake your child actually needs to get better.
■ PORE OVER Books and websites Find out more on the Maudsley method on maudsleyparents.org and thenewmaudsleyapproach.co.uk
British psychiatrist Janet Treasure has written and co-written a series of books on eating disorders - any of these would be of help. Her book Skills-based Learning for Caring for a Loved One with an Eating Disorder is a must-read.
Help Your Teenager Beat an Eating Disorder by James Lock, MD, PhD, and Daniel Le Grange, PhD, is very useful and outlines how to put up a united family front to prevent relapse.
Health & Living