Wednesday, 28 March 2012

Final thoughts

It is a while now since Waif was discharged from the Maudsley.  I go days without thinking about eating disorders and without worrying about my darling girl, and I feel confidence in her future.  When I remember the dark days during which she was so very thin and getting thinner,  I am overwhelmingly grateful to be here, now, with such an optimistic ending.  I wish the same for every single person battling an eating disorder and so I want to summarise my experiences and learning in case it is of any help to others.

I look back and still can't fathom what the Maudsley did that was so magical - they talked to Waif regularly, always with me there, often with her father, and sometimes with her older sister.  They probed into whether she was unhappy in any way (she always denied that she had any unhappiness other than being forced to family therapy) and whether she had suffered trauma when young (nope).  As those drew a blank, we usually simply had her weighed, she was then either praised or sharply ticked off depending on whether she had gained or lost weight, had a discussion about the negative effects of being underweight and then chatted about what she had planned for the next week.    A few times she was threatened with being hospitalised, or kept away from school, and she was banned from sport for a while, and she always put weight on after one of those sessions (I reckon the thought of compulsory feeding in hospital was pretty frightening).   But she never really talked back.

Waif never spoke easily about her motivations - in fact, Waif never spoke at all about them and they are still a mystery.  Perhaps when she is full grown she will share some insights with me.

From the outside (and with nudges from the Maudsley) I would say that she was a vulnerable child because she is such a perfectionist and so bright.  When Waif decided to lose weight, she was not one to mess about with half measures and to lose heart half way through the day and have a Mars Bar.  She does everything properly - with charts (I found those later, the ones she did aged 12 with lists of calories out and calories in, and sad or happy faces depending on how she rated herself).   She was bright enough to do calorie searches on the web and to avoid high calorie foods.  She was also at a very high pressure school which placed no value whatsoever on eating, indeed they made it difficult with their lunch pass system and the arranging of meetings, or detentions, or team practices in the short lunch hour which had long queues and much queue barging.   It was simply easier not to eat between leaving the house at 7.10am in the morning and arriving home on the school bus at 5pm or 6.45pm.

We, her parents, must also shoulder some responsibility.  I suspect we were "fattist" and  inadvertently gave the impression that anyone overweight was faintly to be despised (I don't actually believe that, incidentally).  Not that she was ever overweight, but it can't have helped as she could have extrapolated to thinking that the thinner she was, the more we would love her.  Of course, when I realised she had anorexia and was not eating properly, I emphasised how bad it is to be underweight - so much more dangerous so much more quickly than being overweight, and went to great lengths to explain that there is a broad band of healthy weight and everyone should aim to be in it, but that it does not matter if you are at the slim end or the plump end, just that you are healthy.  And with health comes beauty - clear skin, bright eyes, lustrous hair, a pink complexion.  It annoys me so much (and not much does) when people within a perfectly healthy weight range moan about wanting to lose weight, and refer to food as "naughty".   Why can't they be happy to be healthy and devote their mindspace to more interesting matters than their precise weight which, frankly, nobody else much cares about anyway?  Okay, if you are morbidly obese then you ought to address your lifestyle, but the people I know who worry about extra pounds are a long way from that.   It seems like an indulgence.

Perhaps there was also a little of Waif not wanting to grow up (this was suggested at the Maudsley, not least because Waif still slept in my bed until she was nearly 14).  The world is a frightening place and she has parents who might be seen as high achievers (it doesn't seem that way to me, really, but I can see it is how she would see us) which can pile on the pressure.

In the end, I hope what helped Waif back to health was to know that our love never swerved, that we were there every step of the way and that we were so worried about her that it was obvious to her that getting thin was not a trivial matter.  The fact I gave up my job to be with her, that I cried at night with worry, that we all changed our lives around her, that we moved her school and that I supervised all her eating must together have signalled that this was no game and possibly shocked her a little.  We were lucky that we could make all those changes.

On a practical level, we followed the Maudsley approach which was to provide a regular, compulsory menu of food.  That was the big non-negotiable.   I provided high calorie meals 4 times a day and Waif, bless her, generally ate them - I was not so rigid that I would not let her swap one thing for another (whilst trying not to allow there to be bogey monster foods - advice from the Maudsley - like chips or sauces), and I never hid from her what was in the food and that it WAS high calorie and that that was because she NEEDED to put on weight. I explained that once she was healthy she could cut back to a normal diet as long as she didn't ever become too thin again because she would probably have a life long vulnerability.

At no point did any of us lie to Waif - not about how many calories there were in her food, nor why she needed to eat, nor what would happen to her if she did not.  I feel that maintained some trust.

I also explained to her that physiologically she needed to eat a lot more calories than a normal person in order to put on weight - apparently one's body tries to maintain homeostasis and if you have been a certain weight for more than about 4 months, it resists letting that go up or down (this also explains why dieters have to bear with their diets and keep their weight off for 6 months before they can relax otherwise they will go back up to their pre diet weight).  We never banned healthy food - lots of fruit and veg are always good, although I did have to let go about worrying about her teeth as getting calories into her with sugary snacks was more important than risking some fillings.  Oddly, and happily, her teeth seem to have survived.

Waif now seems to eat normally although we will never again be fully relaxed about eating, I suspect, but we are close.  I am going back to work in September, in a new job working with teenagers, so I need to start trusting Waif to make her own packed lunch, and to be independent of me as she starts in the sixth form.  Gulp, I am just so happy to not be in that alternative universe where instead Waif was hospitalised and angry and still ill.  Thank you to good fortune.  Let me never mind about small worries.

Lastly, but certainly not least, thank you to all my lovely commenters and readers.  I started this blog as a way of recording my own feelings to help me to deal with them, but also as a way of getting advice from those who have "been there" and "done that".  I have found insights from readers who have themselves struggled with eating issues especially illuminating and, often, a good reality check.  I have felt like you are true friends and your support got me through the tough times.  Thank you.