We welcomed Ellie Curtis who works as a teacher at a hospital and school for young people with eating disorders, primarily anorexia. It was a very stimulating and lively talk from someone clearly very thoughtful about her work. She outlined the children’s experience of being hospitalised (and usually sectioned under the mental health act), with particular emphasis on the unwelcome but crucial restraints that have to be imposed to prevent them dying without food. We heard the disturbing lengths that these patients go to in order to avoid food and the medical interventions that have to be imposed. The children see their anorexia as the solution to their problems and are therefore not motivated to recover. ‘No one with anorexia wants to get better’. There is a dilemma that the child is necessarily the centre of attention of an impressive group of professionals. This makes them feel important and might be an incentive to hold on to the illness. Children are hospitalised here for at least several months and often for many years. Happily there have been no deaths at this hospital and there is a high success rate – most children eventually becoming well enough to function outside again. Leaving is a milestone which is deliberately celebrated .
We discussed the theory that feelings are so deeply buried that the anorexia serves as a way of keeping feelings repressed. The control the patients exert over their eating ironically means that the anorexia ends up controlling them. Anorexia was described as a mental illness which manifests itself as a drawn out suicide attempt and this lead to a discussion about the ethics of preventing death in adults with anorexia .
There is no incentive to get better, anorexia to the sufferer is the answer not the problem. Although there is frequently a history of trauma, exploration of feelings in therapy is generally unwelcome and we noted how rarely adult clients present with anorexia. Ellie’s experience is that most of the children do not engage with therapists. Touchingly she talked of the joys of breakthroughs when children begin to relate to her as a teacher.
Relationships between the children are sometimes intense and sometimes there is harsh competition to be the thinnest, the most successful at being anorexic. There is a danger that the children teach each other ingenious ways of avoiding food or burning calories, many exercise compulsively. In terms of family dynamics, Ellie reluctantly admitted that the children in her care very often have problematic relationships with their parents, mothers in particular. Mothers have often had their own experience with anorexia. Fathers are typically left feeling helpless. She also mentioned in passing that they care for a disproportionate number of twins, hypothesising that anorexia could be an unconscious response to competition or comparison between them.
Relationships with the helping adults in the hospital are not always straightforward either. We talked about deceit which is a necessary part of being a successful anorexic. Ellie mentioned the discomfort of feeling suspicious that every positive gesture from a student is likely to be disingenuous. She was so honest about her natural feeling of wanting to be liked by her students whilst knowing that she is probably being manipulated much of the time.
Finally we heard a case study of a student with the very rare condition Pervasive Arousal Withdrawal Syndrome (PAWS) where the child had withdrawn from all physical activity including eating, speaking, moving. In this case, the person was detached for several years before slowly reengaging.