1 00:00:02,000 --> 00:00:04,560 Would you have known I was anorexic if you saw me in the street? 2 00:00:04,560 --> 00:00:07,040 I don't know how to judge that. Am I supposed to say yes or no? 3 00:00:07,040 --> 00:00:09,520 - I don't know. - I want you to say yes. 4 00:00:09,520 --> 00:00:11,280 If you say "I didn't," 5 00:00:11,280 --> 00:00:14,440 then I would just stop eating again, until you say yes. 6 00:00:14,440 --> 00:00:16,480 So that's why I'm not going to answer that. 7 00:00:16,480 --> 00:00:19,320 - I know, I noticed that. - I don't want to play that game. 8 00:00:19,320 --> 00:00:22,600 - Yeah, it's a game. - Just by having this, you know, fleeting encounter, 9 00:00:22,600 --> 00:00:24,120 I've sort of been... 10 00:00:25,480 --> 00:00:28,000 ..sucked into this psycho drama. 11 00:00:28,000 --> 00:00:31,760 Things that would be ordinary conversations, suddenly are charged. 12 00:00:31,760 --> 00:00:34,680 You know, I might say something that could make your illness worse. 13 00:00:34,680 --> 00:00:37,520 You could say something that could stop me eating for a week. 14 00:00:37,520 --> 00:00:40,600 You could say something that will stop me going out for a week and not 15 00:00:40,600 --> 00:00:43,160 realise you said it, but that's not your fault. 16 00:00:43,160 --> 00:00:45,080 I'm the one with the problem, not you. 17 00:00:50,520 --> 00:00:55,000 I've been spending time among people afflicted by a most mysterious 18 00:00:55,000 --> 00:00:57,560 and sometimes fatal mental disorder. 19 00:01:02,840 --> 00:01:07,040 Anorexia, a pathological fear of eating and gaining weight. 20 00:01:08,720 --> 00:01:10,280 I can't see a future. 21 00:01:10,280 --> 00:01:14,320 - Why? - Because I don't think I'll be alive long! 22 00:01:14,320 --> 00:01:17,080 I was hoping to get some insight into its causes. 23 00:01:18,720 --> 00:01:20,720 How it affects patients and families. 24 00:01:20,720 --> 00:01:23,520 - SHE SOBS - Sh, sh, sh. 25 00:01:23,520 --> 00:01:27,440 And, with a bit of luck, some understanding of a way out. 26 00:01:27,440 --> 00:01:31,000 The only way is up now and you're in the right place. 27 00:01:33,320 --> 00:01:34,640 Yeah. 28 00:01:48,400 --> 00:01:52,080 At Saint Ann's Hospital in North London, I was on Phoenix Wing. 29 00:01:52,080 --> 00:01:55,040 An inpatient ward for people with eating disorders. 30 00:01:55,040 --> 00:01:56,520 Hi, Rosie. How are you? 31 00:01:56,520 --> 00:01:58,400 I'm good. 32 00:01:58,400 --> 00:01:59,960 A dentist's assistant, 33 00:01:59,960 --> 00:02:03,600 Rosie had admitted herself for treatment three months earlier. 34 00:02:03,600 --> 00:02:05,400 What's it like being here? 35 00:02:05,400 --> 00:02:07,000 - BACKGROUND: - Prison! 36 00:02:07,000 --> 00:02:08,840 "Prison", someone said! 37 00:02:08,840 --> 00:02:11,120 Yeah, pretty much. 38 00:02:11,120 --> 00:02:15,640 - Prison. Kath... - Did you mean that? - Yes, she did. 39 00:02:15,640 --> 00:02:17,120 She did. 40 00:02:17,120 --> 00:02:22,880 Yeah, like, it's definitely military, like, very time-consuming. 41 00:02:22,880 --> 00:02:24,760 Yes, there's a routine. 42 00:02:24,760 --> 00:02:27,040 - It's a structure. - It's a strict schedule. 43 00:02:27,040 --> 00:02:28,960 That's your schedule, is it? 44 00:02:28,960 --> 00:02:31,800 - Yeah. - It starts around 8:30am. 45 00:02:31,800 --> 00:02:37,000 We had breakfast and then we had snack - is 10:10am till 10:25am. 46 00:02:37,000 --> 00:02:40,000 And then from half eight till half nine we have supervision period, 47 00:02:40,000 --> 00:02:42,080 which is taken in the lounge. 48 00:02:42,080 --> 00:02:44,080 Toilets are locked, as well. 49 00:02:44,080 --> 00:02:45,360 After mealtimes? 50 00:02:45,360 --> 00:02:49,440 During mealtimes and after for that half-an-hour period. 51 00:02:49,440 --> 00:02:51,880 Some of us are on one-to-ones, 52 00:02:51,880 --> 00:02:55,800 which means, after supervision, when you do go to the toilet, 53 00:02:55,800 --> 00:02:59,240 a member of staff will come in that toilet with you. 54 00:02:59,240 --> 00:03:02,320 Because they've got to make sure you're not just eating the meals 55 00:03:02,320 --> 00:03:05,040 - but keeping... - Them down. - Keeping them down. 56 00:03:05,040 --> 00:03:08,080 - Yeah. - And so with you it was more a case of, sort of, 57 00:03:08,080 --> 00:03:10,920 not eating food in the first place? 58 00:03:10,920 --> 00:03:16,120 Yeah, I got a thrill out of... Not eating, starving myself, yeah. 59 00:03:16,120 --> 00:03:20,680 Just skipping meals, just because I didn't think it was necessary. 60 00:03:20,680 --> 00:03:23,920 - Really? Did you say you got a thrill out of it? - Mm. 61 00:03:23,920 --> 00:03:25,440 Would you call it a thrill? 62 00:03:26,640 --> 00:03:30,160 Now, looking back on it, no, but at the time, yeah. 63 00:03:38,080 --> 00:03:40,320 I suppose I'm curious to know how long you've been ill. 64 00:03:40,320 --> 00:03:42,600 That's one question I have. 65 00:03:42,600 --> 00:03:46,400 - I would say the illness started in October of last year. - Uh-hm. 66 00:03:46,400 --> 00:03:50,280 It got to Christmas and I still was in denial how much I was losing, 67 00:03:50,280 --> 00:03:53,080 but everyone around me was like, "You're losing a lot now, 68 00:03:53,080 --> 00:03:57,080 "we can see it." And then February, just went crashing down. 69 00:03:57,080 --> 00:03:59,920 I lost all physical movement. 70 00:03:59,920 --> 00:04:02,960 I couldn't walk, I was crawling up the stairs, 71 00:04:02,960 --> 00:04:06,240 I was having to get my dad to carry me up the stairs. 72 00:04:06,240 --> 00:04:09,120 I lost eyesight, I lost my hearing. 73 00:04:10,320 --> 00:04:12,800 In late February, we're talking? 74 00:04:12,800 --> 00:04:16,080 - Yeah. - Due to malnutrition, basically. 75 00:04:16,080 --> 00:04:19,720 You can lose your eyesight and your hearing because of diet 76 00:04:19,720 --> 00:04:22,320 - and lack of food? - Yeah. 77 00:04:22,320 --> 00:04:25,560 If I didn't come in that day, I could have died. 78 00:04:25,560 --> 00:04:27,800 I was nearly at cardiac arrest. 79 00:04:27,800 --> 00:04:30,600 And you've been living here ever since. 80 00:04:30,600 --> 00:04:33,320 - Yeah. - As an inpatient, but going home at weekends. 81 00:04:33,320 --> 00:04:37,000 Yeah, I do do overnights and weekends at home. 82 00:04:37,000 --> 00:04:40,200 When I get weighed on the Monday and Thursday, I feel happy that I'm 83 00:04:40,200 --> 00:04:42,720 putting on, but it does scare me, like, I don't want to... 84 00:04:43,760 --> 00:04:45,880 If I'm being honest, I don't want to come out of here 85 00:04:45,880 --> 00:04:47,960 and then get to the point where I'm overweight. 86 00:04:47,960 --> 00:04:50,520 And obviously I've got a target to aim towards. 87 00:04:50,520 --> 00:04:53,360 So I never want to go over that because then I'll freak out. 88 00:04:59,920 --> 00:05:01,160 Hello. 89 00:05:03,840 --> 00:05:06,480 Every fortnight, doctors and therapists meet 90 00:05:06,480 --> 00:05:09,800 to discuss their patients' progress and monitor their weight. 91 00:05:11,200 --> 00:05:13,040 I was meeting Rosie's team. 92 00:05:14,560 --> 00:05:17,960 That's a graph of Rosie's weight, is it? 93 00:05:17,960 --> 00:05:23,080 - Yes. - Basically. And it's dropping precipitously until a certain point. 94 00:05:23,080 --> 00:05:26,280 And what does that point represent? 95 00:05:26,280 --> 00:05:29,080 I think the lowest weight on that weight chart is where we... 96 00:05:29,080 --> 00:05:31,320 At the point of admission. 97 00:05:31,320 --> 00:05:33,760 So, she was dropping weight at quite a rate 98 00:05:33,760 --> 00:05:35,600 when she was an outpatient. 99 00:05:35,600 --> 00:05:39,360 So you could see that there was a need for a change of approach? 100 00:05:40,360 --> 00:05:43,920 What is the line that's going off at a steeper angle... 101 00:05:43,920 --> 00:05:45,760 Steeper gradient? 102 00:05:45,760 --> 00:05:48,880 So, the bottom line is half a kilo weight gain a week, 103 00:05:48,880 --> 00:05:51,720 so generally if people are falling within the two lines, 104 00:05:51,720 --> 00:05:54,400 then the rate of weight gain is what we would expect. 105 00:05:54,400 --> 00:05:56,760 Right. And that's interesting, isn't it? 106 00:05:56,760 --> 00:06:01,880 Because she's hugging that lower benchmark amazingly closely, 107 00:06:01,880 --> 00:06:05,120 almost as though she's sort of deliberately doing the minimum 108 00:06:05,120 --> 00:06:09,440 - acceptable weight gain. - Even yesterday, after the session, 109 00:06:09,440 --> 00:06:12,360 she said to me, "Sometimes I still don't believe 110 00:06:12,360 --> 00:06:14,160 "that I've got this illness." 111 00:06:18,480 --> 00:06:21,240 Inpatient units like Phoenix Wing cater 112 00:06:21,240 --> 00:06:24,080 to the most serious cases of anorexia. 113 00:06:24,080 --> 00:06:25,760 What's your name? 114 00:06:25,760 --> 00:06:28,040 - Ifzana. - Louis. - Nice to meet you. 115 00:06:28,040 --> 00:06:31,200 The condition has been on the increase in the UK, 116 00:06:31,200 --> 00:06:34,680 amongst women and men, whether because of fashion images, 117 00:06:34,680 --> 00:06:38,800 social media or other more complex reasons. 118 00:06:38,800 --> 00:06:42,080 Have you done inpatient recovery of this sort before? 119 00:06:42,080 --> 00:06:43,800 Oh, yes. I'm a veteran. 120 00:06:43,800 --> 00:06:45,960 OK. 121 00:06:45,960 --> 00:06:48,920 Treatment revolves around a timetable of three meals 122 00:06:48,920 --> 00:06:52,720 and three snacks every day, all strictly supervised. 123 00:06:53,760 --> 00:06:56,160 I don't particularly want to eat this cake and ice cream 124 00:06:56,160 --> 00:06:58,880 but I know that I have to. It's part of my treatment. 125 00:07:00,280 --> 00:07:03,640 Patients also receive therapy and classes in shopping for 126 00:07:03,640 --> 00:07:07,200 and preparing food, to help them build a healthier relationship 127 00:07:07,200 --> 00:07:08,840 with eating. 128 00:07:08,840 --> 00:07:11,960 Are you aware that you need some fats in your diet? 129 00:07:12,960 --> 00:07:15,440 The aim is for patients to regain their weight 130 00:07:15,440 --> 00:07:17,960 and return to living in the outside world. 131 00:07:25,400 --> 00:07:28,360 At a clinic in West London, called Vincent Square, 132 00:07:28,360 --> 00:07:31,600 I was meeting a daytime patient called Jess. 133 00:07:31,600 --> 00:07:34,600 - How's it going? - Hiya. - We met very briefly before, didn't we? 134 00:07:34,600 --> 00:07:36,400 - Yeah. - Louis. 135 00:07:36,400 --> 00:07:38,000 - Jess. - Am I all right here? 136 00:07:38,000 --> 00:07:40,080 Yeah, of course. 137 00:07:40,080 --> 00:07:43,000 Jess had been in treatment for nine years. 138 00:07:43,000 --> 00:07:45,760 Joining us was her nurse, James Kelly. 139 00:07:45,760 --> 00:07:47,960 So how long have you been here? 140 00:07:47,960 --> 00:07:50,280 I've been here just over a year. 141 00:07:50,280 --> 00:07:52,440 A year last week, I had my anniversary. 142 00:07:52,440 --> 00:07:54,320 - How old are you? - I'm 27. 143 00:07:54,320 --> 00:07:56,080 - 27. - 28, next week. 144 00:07:56,080 --> 00:07:58,640 And when did you first get diagnosed? 145 00:07:58,640 --> 00:08:00,720 I was 19. 146 00:08:00,720 --> 00:08:02,200 OK. 147 00:08:10,400 --> 00:08:14,520 Jess, is it the last six birthdays you've spent in hospital? 148 00:08:14,520 --> 00:08:16,560 - Yeah, last five. - Last five. - Yeah. 149 00:08:17,760 --> 00:08:23,000 And this kind of pattern of kind of going round again has been your life 150 00:08:23,000 --> 00:08:24,800 for the last five, six years. 151 00:08:25,960 --> 00:08:28,520 What's your sense of how Jess is doing? 152 00:08:28,520 --> 00:08:33,680 Things are slipping and deteriorating kind of physically. 153 00:08:33,680 --> 00:08:37,120 - Jess is struggling. - And how do you define that? 154 00:08:37,120 --> 00:08:40,080 Less food and more walking. 155 00:08:40,080 --> 00:08:41,760 You've been doing more walking. 156 00:08:43,160 --> 00:08:47,760 Yeah, I do quite a lot of walking and other exercise, as well. 157 00:08:49,000 --> 00:08:51,320 I really struggle with exercise. 158 00:08:51,320 --> 00:08:53,360 It's amazing. I'm still quite new to this. 159 00:08:53,360 --> 00:08:56,600 The idea of struggling with exercise to me still means 160 00:08:56,600 --> 00:08:58,440 that you need to do more! 161 00:08:58,440 --> 00:09:01,920 But you actually mean that you need to do less? 162 00:09:01,920 --> 00:09:06,560 Yeah, I mean, I do star jumps, as well, which is a bit of an issue. 163 00:09:06,560 --> 00:09:09,360 I've been doing them for years and years and never been able to break 164 00:09:09,360 --> 00:09:14,000 - the habit. - How many star jumps do you do? Here? 165 00:09:15,080 --> 00:09:18,240 Well, at the moment, I do, like, 2,000 day. 166 00:09:20,200 --> 00:09:21,880 I feel really ashamed. 167 00:09:21,880 --> 00:09:23,840 It's made you feel ashamed, talking about that? 168 00:09:23,840 --> 00:09:25,920 Yeah, and... Quite... 169 00:09:25,920 --> 00:09:27,680 I don't know. 170 00:09:27,680 --> 00:09:30,680 It's quite hard to admit it and to let people know about it. 171 00:09:31,760 --> 00:09:34,400 Feels like a bit of a shameful secret that I have to hide. 172 00:09:34,400 --> 00:09:38,680 But in your case it seems to me that they are a symptom of your illness. 173 00:09:39,920 --> 00:09:42,640 Again, to which no shame should be attached. 174 00:09:42,640 --> 00:09:45,280 - That's an illness. - Yeah. 175 00:09:52,880 --> 00:09:56,160 Jess came from a family of successful lawyers. 176 00:09:56,160 --> 00:09:58,000 She dreamed of becoming a teacher. 177 00:09:59,200 --> 00:10:01,440 Although she'd graduated from university, 178 00:10:01,440 --> 00:10:04,040 she'd never had a full-time job, due to her illness. 179 00:10:04,040 --> 00:10:08,200 That's my sister's graduation, when I was nearly a healthy weight. 180 00:10:08,200 --> 00:10:10,480 - Which one are you? - This one. - Wow. 181 00:10:18,000 --> 00:10:19,440 - Is that you? - Yeah. 182 00:10:22,200 --> 00:10:25,320 - Same time? - No, that was when I was about 17. 183 00:10:25,320 --> 00:10:27,560 - Can I keep going? - Yeah, I guess. 184 00:10:27,560 --> 00:10:29,480 Not going to find anything weird. 185 00:10:29,480 --> 00:10:31,200 No, it's not going to be weird. 186 00:10:31,200 --> 00:10:32,600 That's a joke. 187 00:10:34,800 --> 00:10:37,240 A lot of people kind of say things to me, like, 188 00:10:37,240 --> 00:10:39,640 you used to be so pretty, or you'd be so beautiful 189 00:10:39,640 --> 00:10:42,680 if you gained some weight, and that's just missing the point 190 00:10:42,680 --> 00:10:46,640 entirely because I'm under no illusion that I'm attractive 191 00:10:46,640 --> 00:10:50,560 as I am now or that I would be any more attractive if I lost weight, 192 00:10:50,560 --> 00:10:52,480 but I still want to lose weight. 193 00:10:52,480 --> 00:10:54,200 It's not about being attractive. 194 00:11:01,760 --> 00:11:03,880 What do you think the misconceptions are? 195 00:11:05,160 --> 00:11:08,120 I guess that it's, perhaps, a self... 196 00:11:09,600 --> 00:11:14,600 An attention-seeking thing and that it's all because the media portrays 197 00:11:14,600 --> 00:11:17,840 this image that the ideal size is a size zero and all that stuff 198 00:11:17,840 --> 00:11:20,280 and it's not about that at all, like... 199 00:11:22,280 --> 00:11:23,920 People just don't get it. 200 00:11:24,920 --> 00:11:27,080 If you accept it's not about a size zero, 201 00:11:27,080 --> 00:11:29,320 although probably those images aren't helpful... 202 00:11:29,320 --> 00:11:32,960 - Yeah. - Do you have any sense of where it does come from? 203 00:11:34,280 --> 00:11:36,160 I think it's a mixture of things. 204 00:11:36,160 --> 00:11:38,360 It's partly a self-punishment thing, 205 00:11:38,360 --> 00:11:40,800 thinking that I don't deserve to eat, 206 00:11:40,800 --> 00:11:45,120 I don't deserve nice things, I don't deserve to enjoy myself and... 207 00:11:45,120 --> 00:11:49,200 ..I restrict food and exercise as a punishment to myself. 208 00:11:49,200 --> 00:11:50,760 But then, conversely, 209 00:11:50,760 --> 00:11:53,800 it's also a control thing and an anxiety thing that at times 210 00:11:53,800 --> 00:11:55,720 it actually makes me feel better. 211 00:11:57,000 --> 00:12:00,200 I guess what I'm curious about is what sort of emotions 212 00:12:00,200 --> 00:12:03,960 or what feelings you would get from eating, for example. 213 00:12:03,960 --> 00:12:08,280 I feel so guilty and disgusting. 214 00:12:08,280 --> 00:12:12,200 I just want to, like, physically tear the skin off me 215 00:12:12,200 --> 00:12:16,080 and the fat off me and just... It's just awful. 216 00:12:16,080 --> 00:12:17,760 In my head, I shouldn't like food, 217 00:12:17,760 --> 00:12:20,480 it's disgusting and greedy and horrible to like food 218 00:12:20,480 --> 00:12:25,080 and that makes me a fat, greedy pig and I shouldn't let the world know 219 00:12:25,080 --> 00:12:28,280 that, actually, I do like the taste of some foods! 220 00:12:33,080 --> 00:12:34,640 As at Phoenix Ward, 221 00:12:34,640 --> 00:12:38,320 patients at Vincent Square spend most of their time eating meals 222 00:12:38,320 --> 00:12:40,280 and attending therapeutic groups. 223 00:12:41,880 --> 00:12:44,360 The average stay is around four months, 224 00:12:44,360 --> 00:12:48,240 but it's not uncommon for inpatients to stay a year or longer, 225 00:12:48,240 --> 00:12:50,000 and many return. 226 00:12:51,960 --> 00:12:55,040 The clinical director is Dr Frances Connan. 227 00:12:55,040 --> 00:12:58,240 Anorexia is a mental illness, that's correct, isn't it? 228 00:12:58,240 --> 00:13:01,840 Yeah. And one of the things we always say about anorexia 229 00:13:01,840 --> 00:13:04,840 as a mark of its seriousness, is it has the highest mortality 230 00:13:04,840 --> 00:13:06,440 of any psychiatric disorder. 231 00:13:06,440 --> 00:13:07,880 And that's staggering. 232 00:13:07,880 --> 00:13:10,280 Do we know what causes it? 233 00:13:10,280 --> 00:13:12,840 None of us can really say we know what the cause 234 00:13:12,840 --> 00:13:14,240 of anorexia nervosa is. 235 00:13:14,240 --> 00:13:17,840 There are biological factors as well as psychological factors that 236 00:13:17,840 --> 00:13:21,520 contribute. So it's things like personality type. 237 00:13:21,520 --> 00:13:25,920 People who have more obsessive-compulsive type 238 00:13:25,920 --> 00:13:30,000 personality traits, perfectionism, and those interact 239 00:13:30,000 --> 00:13:33,920 with life experience to come together to cause the expression 240 00:13:33,920 --> 00:13:35,160 of the illness. 241 00:13:35,160 --> 00:13:37,200 So how do you help... 242 00:13:37,200 --> 00:13:40,320 How do you treat the people that you see here? 243 00:13:40,320 --> 00:13:44,960 So, one of the ways we can help you get better and stay well is to help 244 00:13:44,960 --> 00:13:50,000 build resilience in emotional coping and interpersonal coping, so that you 245 00:13:50,000 --> 00:13:54,200 don't have to rely on not eating as a way of coping with the world 246 00:13:54,200 --> 00:13:55,960 and as a response to stress. 247 00:14:04,280 --> 00:14:07,720 People with anorexia tend to experience their first symptoms 248 00:14:07,720 --> 00:14:10,880 in their late teens and early 20s. 249 00:14:10,880 --> 00:14:14,560 Many go on to wrestle with the illness throughout their lives. 250 00:14:14,560 --> 00:14:17,400 I was meeting 63-year-old Janet. 251 00:14:17,400 --> 00:14:20,200 - Hi, Janet. - Hi, Louis, how are you? - Louis. - Thank you for coming. 252 00:14:20,200 --> 00:14:21,680 Thank you, thank you for having me. 253 00:14:21,680 --> 00:14:22,880 You're welcome. 254 00:14:22,880 --> 00:14:24,400 - Come in. - Show me the way. 255 00:14:24,400 --> 00:14:25,680 OK. All right. 256 00:14:27,520 --> 00:14:28,960 Mind the step. 257 00:14:32,880 --> 00:14:34,760 I've just had my breakfast. 258 00:14:34,760 --> 00:14:37,240 - Did you? - Yes, which took, like, two seconds. 259 00:14:37,240 --> 00:14:43,000 - What did you have? - I had that much of bread and a tiny bit of cheese. 260 00:14:43,000 --> 00:14:44,880 But now I feel like I have to walk it off. 261 00:14:44,880 --> 00:14:48,160 - Why? - Because I can't bear the calories inside me. 262 00:14:50,680 --> 00:14:54,960 Janet first experienced symptoms aged 18. 263 00:14:54,960 --> 00:14:59,240 She was diagnosed at 33 and has spent most of her life since as an 264 00:14:59,240 --> 00:15:02,960 outpatient at Vincent Square, while living at home 265 00:15:02,960 --> 00:15:05,040 and working at a job centre. 266 00:15:05,040 --> 00:15:08,400 These are crackers. I cannot eat a whole cracker. 267 00:15:08,400 --> 00:15:12,200 If I eat a whole cracker, the guilt is horrendous. 268 00:15:12,200 --> 00:15:17,400 I can't do it. So what I do, I shake it up... 269 00:15:18,560 --> 00:15:20,680 Shake it up, right? 270 00:15:20,680 --> 00:15:22,440 And then I just take a little bit. 271 00:15:22,440 --> 00:15:24,360 So that I would have for lunch. 272 00:15:24,360 --> 00:15:26,160 - That's my lunch. - Are you serious? 273 00:15:26,160 --> 00:15:27,600 Yeah, I'm being serious. 274 00:15:27,600 --> 00:15:29,440 Would I joke about something like this? 275 00:15:29,440 --> 00:15:32,240 I have to go for a walk, an hour's walk after I've eaten this. 276 00:15:32,240 --> 00:15:35,560 Or for a change, I might have that. 277 00:15:35,560 --> 00:15:38,120 I don't want to get bored with the same thing. 278 00:15:38,120 --> 00:15:39,920 Yeah? Or one of these. 279 00:15:41,040 --> 00:15:43,760 But that, I would have to break in half because I couldn't cope with 280 00:15:43,760 --> 00:15:45,960 - eating the whole one. - You said you loved the biscuit 281 00:15:45,960 --> 00:15:48,360 - but you don't enjoy eating it. - Because of the guilt. 282 00:15:48,360 --> 00:15:49,680 But you love eating it? 283 00:15:49,680 --> 00:15:51,400 There's two sides to me. 284 00:15:51,400 --> 00:15:53,520 There's one that's anorexic, and one that isn't. 285 00:15:53,520 --> 00:15:57,760 One that's trying to get better, and one that is the anorexic. 286 00:15:57,760 --> 00:16:00,320 And one is saying, you shouldn't be doing this. 287 00:16:00,320 --> 00:16:03,840 And the anorexic is saying, but this is all I've ever known. 288 00:16:03,840 --> 00:16:05,320 I'm your best friend. 289 00:16:05,320 --> 00:16:08,680 - Which side is bigger? - The anorexic. 290 00:16:08,680 --> 00:16:09,720 How much bigger? 291 00:16:10,760 --> 00:16:13,040 A lot bigger. 99%. 292 00:16:15,040 --> 00:16:16,480 Are those chocolates? 293 00:16:16,480 --> 00:16:19,160 Yeah. I'm allowed one a month. 294 00:16:19,160 --> 00:16:21,800 The first of every month I get so excited because I'm allowed 295 00:16:21,800 --> 00:16:24,200 a little bit of ice cream and one chocolate. 296 00:16:24,200 --> 00:16:25,400 Do you want one? 297 00:16:26,480 --> 00:16:28,080 - Are you going to have one? - No. 298 00:16:29,120 --> 00:16:31,480 No, because it's not the 1st of July yet. 299 00:16:31,480 --> 00:16:33,720 - Where did that rule come from? - I don't know. 300 00:16:33,720 --> 00:16:36,200 But that's what I let myself have, one a month. 301 00:16:36,200 --> 00:16:38,680 My sweets. I can't eat a whole one. 302 00:16:38,680 --> 00:16:41,960 I have to boil it down, and I'll suck it again a bit later. 303 00:16:41,960 --> 00:16:43,360 That will last me a week. 304 00:16:43,360 --> 00:16:46,840 - Really? - That's four weeks' worth of sweets there. 305 00:16:46,840 --> 00:16:48,360 Hard sweets. 306 00:16:48,360 --> 00:16:51,160 - Really? - Why have you got several on the go at once? 307 00:16:51,160 --> 00:16:53,960 Because then psychologically I don't feel like I'm eating too many. 308 00:16:57,440 --> 00:16:58,640 They call me nuts! 309 00:16:58,640 --> 00:17:00,400 LAUGHTER 310 00:17:06,640 --> 00:17:08,040 Look at my hands. 311 00:17:09,040 --> 00:17:10,520 What's happened to your nails? 312 00:17:10,520 --> 00:17:14,400 Because I'm not eating, the circulation is not working now. 313 00:17:14,400 --> 00:17:18,200 - My body's packing up. - That's why they're red like that, reddy-purple? 314 00:17:18,200 --> 00:17:19,480 Purple. 315 00:17:23,520 --> 00:17:24,920 - They're quite cold. - Mm. 316 00:17:27,520 --> 00:17:29,720 It's a nightmare, this is a nightmare. 317 00:17:29,720 --> 00:17:31,640 I've had it since I was 18. I'm 63. 318 00:17:31,640 --> 00:17:34,920 But there's something stopping you from eating. 319 00:17:34,920 --> 00:17:36,080 What is it? 320 00:17:38,560 --> 00:17:45,880 I feel if I eat then I've lost control and if I eat... 321 00:17:45,880 --> 00:17:49,360 When you're starving, it gets so bad that you feel pain. 322 00:17:49,360 --> 00:17:50,760 It numbs everything. 323 00:17:50,760 --> 00:17:53,920 It numbs your thinking, you can't think straight. 324 00:17:53,920 --> 00:17:56,680 If something happens, like when my mum died and my sister died, 325 00:17:58,040 --> 00:18:02,200 I didn't feel the pain, because I was numb - I was so hungry. 326 00:18:02,200 --> 00:18:04,040 You want to be well. 327 00:18:04,040 --> 00:18:06,440 - I do. - I'm getting very mixed messages. 328 00:18:07,480 --> 00:18:08,680 It's not an easy one. 329 00:18:08,680 --> 00:18:10,320 It's really confusing. 330 00:18:12,440 --> 00:18:14,000 I don't feel I deserve... 331 00:18:15,960 --> 00:18:17,760 I don't feel I deserve... 332 00:18:17,760 --> 00:18:20,040 I don't feel I deserve. 333 00:18:20,040 --> 00:18:23,040 Is that what it is? Unworthiness? 334 00:18:23,040 --> 00:18:26,880 I'll eat off the floor, I'll eat out my bin. 335 00:18:28,640 --> 00:18:31,920 But if somebody buys me something, I'll throw it away. 336 00:18:33,840 --> 00:18:37,840 I don't feel I deserve nice clothes. 337 00:18:37,840 --> 00:18:40,320 When my sister died, I thought it should have been me. 338 00:18:44,280 --> 00:18:45,760 It was striking that Janet, 339 00:18:45,760 --> 00:18:49,440 with 40 years of experience with the illness and insight into its 340 00:18:49,440 --> 00:18:51,400 workings, was still struggling. 341 00:18:57,240 --> 00:18:59,560 - Do you want to do it? - Yeah, let's go. - You lead the way. 342 00:19:01,320 --> 00:19:03,680 Less than a year into her anorexia, 343 00:19:03,680 --> 00:19:06,240 Rosie was still coming to terms with the illness. 344 00:19:08,840 --> 00:19:12,240 It was the weekend. Rosie's dad, Paul, was picking her up 345 00:19:12,240 --> 00:19:14,240 for her home leave. 346 00:19:14,240 --> 00:19:16,480 - Paul. Louis. - Nice to meet you, Louis. - How's it going? 347 00:19:16,480 --> 00:19:18,640 - All right, thank you. - Nice to meet you. - And you. 348 00:19:21,640 --> 00:19:25,680 The life-changing nature of anorexia means that it puts huge strains 349 00:19:25,680 --> 00:19:27,960 on families. 350 00:19:27,960 --> 00:19:30,920 I was curious to hear the perspective of her parents. 351 00:19:32,920 --> 00:19:34,640 - Hi, Heather, Louis. - Hi, Louis, all right? 352 00:19:34,640 --> 00:19:36,280 - Yeah, how are you doing? - I'm fine, you? 353 00:19:36,280 --> 00:19:39,240 - Nice to meet you. - And you. - Thanks for having us. - That's all right. 354 00:19:49,040 --> 00:19:51,040 - Go on, then. - No, oh, God, no. 355 00:19:53,640 --> 00:19:56,000 - Glasses. - Yeah, I do wear glasses. 356 00:19:56,000 --> 00:19:57,560 That's a nice look, I think. 357 00:19:57,560 --> 00:19:59,040 It is not! 358 00:20:01,480 --> 00:20:03,600 You were going to show me that one up there. 359 00:20:03,600 --> 00:20:05,760 That's my one of last year. 360 00:20:05,760 --> 00:20:07,240 I was going out on a night out. 361 00:20:09,320 --> 00:20:12,120 And, yeah, that's usually on a typical night out. 362 00:20:12,120 --> 00:20:14,040 - What I do is... - Take about 30 pictures. 363 00:20:14,040 --> 00:20:15,200 Take about 30 pictures. 364 00:20:15,200 --> 00:20:16,760 And put them on Instagram? 365 00:20:16,760 --> 00:20:21,680 - Or just choose the best one? - Choose the best one, yeah. 366 00:20:21,680 --> 00:20:23,400 So, there was nothing in the background, 367 00:20:23,400 --> 00:20:26,600 no inkling that you might have this illness in your future. 368 00:20:26,600 --> 00:20:28,240 Nothing at all. 369 00:20:28,240 --> 00:20:30,080 If I thought I would be here in a year's... 370 00:20:30,080 --> 00:20:32,320 Like, a year before, I would have just laughed at you. 371 00:20:32,320 --> 00:20:33,840 - But you nearly died, in fact. - Mm. 372 00:20:34,840 --> 00:20:36,160 Yeah. 373 00:20:37,280 --> 00:20:39,440 - You were working... - I kind of wanted to. 374 00:20:39,440 --> 00:20:41,280 You wanted to die? 375 00:20:41,280 --> 00:20:42,800 - Why? - Because I gave up. 376 00:20:44,200 --> 00:20:46,520 I gave up, I couldn't do it any more. 377 00:20:46,520 --> 00:20:48,960 Kept telling my mum and dad I wanted myself dead. 378 00:20:56,440 --> 00:20:58,000 - You all right? - Yeah. 379 00:20:58,000 --> 00:21:00,280 Fine. Yeah, coping. 380 00:21:00,280 --> 00:21:01,960 - Coping. - Must be difficult. 381 00:21:03,280 --> 00:21:04,600 We just take day by day. 382 00:21:05,720 --> 00:21:10,120 Day by day now. We couldn't have coped no longer at home. 383 00:21:10,120 --> 00:21:11,360 Couldn't have done no longer. 384 00:21:11,360 --> 00:21:13,600 It must have been shattering to go through. 385 00:21:13,600 --> 00:21:15,960 It was... God... 386 00:21:17,720 --> 00:21:21,480 You couldn't sleep at night, thinking, thinking, thinking, 387 00:21:21,480 --> 00:21:22,760 thinking all the time. 388 00:21:22,760 --> 00:21:25,000 You know, what do we do? 389 00:21:25,000 --> 00:21:26,920 What do we do? Where do we take her? 390 00:21:26,920 --> 00:21:28,600 Terrible, terrible times. 391 00:21:30,320 --> 00:21:32,720 It's like a living, living, living hell. 392 00:21:37,400 --> 00:21:42,120 It all started when I feel like I got rejected by someone 393 00:21:42,120 --> 00:21:46,920 and I just felt like I had to change, but then, 394 00:21:46,920 --> 00:21:48,920 now I think back, why did I? 395 00:21:48,920 --> 00:21:50,400 Why did I change? 396 00:21:50,400 --> 00:21:53,200 You must have known something was up. 397 00:21:53,200 --> 00:21:56,480 I did, but I was just hoping and praying, 398 00:21:56,480 --> 00:21:58,880 please stop going to the gym. 399 00:21:58,880 --> 00:22:01,720 I thought once she'd stopped the gym, 400 00:22:01,720 --> 00:22:05,000 perhaps it might have gotten back. 401 00:22:05,000 --> 00:22:06,560 This might have all just stopped. 402 00:22:06,560 --> 00:22:07,840 I thought it was just a phase. 403 00:22:07,840 --> 00:22:11,560 And the trouble is, you're just trying to keep her happy because, 404 00:22:11,560 --> 00:22:14,520 at the end of the day, that's what she wanted to do 405 00:22:14,520 --> 00:22:15,880 and I was frightened if I... 406 00:22:15,880 --> 00:22:17,720 - They were scared of me. - Why? 407 00:22:17,720 --> 00:22:19,520 - They were scared of me. - A lot of anger. 408 00:22:19,520 --> 00:22:21,440 A lot of anger. 409 00:22:21,440 --> 00:22:24,680 Not scared, in a way... But I was frightened that she... 410 00:22:24,680 --> 00:22:27,720 - No, you were, you were scared. - She much turn around and go, well, 411 00:22:27,720 --> 00:22:30,200 if you don't do this for me, then I'm just going to leave 412 00:22:30,200 --> 00:22:33,360 - and what have you. - I'm going to harm myself or do something... 413 00:22:33,360 --> 00:22:36,680 - Silly. - You sound very confident saying they were scared of you. 414 00:22:36,680 --> 00:22:38,320 - Based on...? - Yeah. 415 00:22:38,320 --> 00:22:41,040 I know they were scared. They were scared to say no. 416 00:22:41,040 --> 00:22:45,080 - Why? - Because they know that if I didn't get what I wanted... 417 00:22:46,680 --> 00:22:49,040 ..then I would just lose my temper. 418 00:22:49,040 --> 00:22:51,360 I knew how to push their buttons. 419 00:22:51,360 --> 00:22:54,000 - It give you a lot of power, I suppose. - Mm. 420 00:22:57,600 --> 00:23:00,240 It doesn't matter how much we argue, 421 00:23:00,240 --> 00:23:04,160 you can't go through life going to me, bye, I've blocked you, 422 00:23:04,160 --> 00:23:05,680 I've done this, I've done that. 423 00:23:05,680 --> 00:23:07,000 But then again, that's her... 424 00:23:07,000 --> 00:23:09,400 But I just feel like you're not proud of me. 425 00:23:09,400 --> 00:23:11,720 When I do gain weight, you never go, "Oh, well done." 426 00:23:11,720 --> 00:23:14,240 - I do, babe. - But then when I'm going down in weight, 427 00:23:14,240 --> 00:23:16,720 you just assume it's always me, that it's always my fault. 428 00:23:16,720 --> 00:23:18,960 Yeah, it's my fault but I've tried. 429 00:23:18,960 --> 00:23:21,160 You need to say, "Well done, you've tried." 430 00:23:21,160 --> 00:23:24,240 You can't go, "Oh, well, you've not eaten enough." 431 00:23:24,240 --> 00:23:26,440 You're not there to support me, really, 432 00:23:26,440 --> 00:23:28,360 so that's what their problem is now at the unit, 433 00:23:28,360 --> 00:23:31,520 that you're not supporting me enough in terms of meals. 434 00:23:35,680 --> 00:23:37,240 Whilst on home leave, 435 00:23:37,240 --> 00:23:40,360 Rosie was expected to stick to the hospital's meal plan, 436 00:23:40,360 --> 00:23:43,040 to ensure she continued to gain weight. 437 00:23:51,720 --> 00:23:55,240 The sense I get is, it's quite easy to say the wrong thing. 438 00:23:57,280 --> 00:23:58,560 Yeah, it is. Yeah. 439 00:24:00,280 --> 00:24:01,360 Every day's... 440 00:24:02,760 --> 00:24:04,120 You tread on eggshells. 441 00:24:04,120 --> 00:24:08,200 And then you tiptoe around and then she's aware of that and that makes 442 00:24:08,200 --> 00:24:12,080 - it worse. - Yes. - She feels infantilised, it's like you're being too careful. 443 00:24:12,080 --> 00:24:17,320 Yeah, yeah. Every single time you open your mouth, 444 00:24:17,320 --> 00:24:20,120 you just don't know what reaction you're going to get from her. 445 00:24:21,600 --> 00:24:22,880 Nice? 446 00:24:27,640 --> 00:24:29,160 That's a mixture, Rose? 447 00:24:35,520 --> 00:24:38,320 I still look at her and I still don't think she's right. 448 00:24:38,320 --> 00:24:42,680 - In what way? - She's still looking at her phone, plates of food. 449 00:24:42,680 --> 00:24:44,920 What do you mean, looking at her phone? 450 00:24:44,920 --> 00:24:50,000 She seems to get the phone and just, all different meals, 451 00:24:50,000 --> 00:24:54,040 she just sits there looking at them, scrolling through them all the time. 452 00:24:55,080 --> 00:24:56,840 We don't say anything as we walk past her, 453 00:24:56,840 --> 00:24:59,280 but we can see what she's doing, like a habit. 454 00:25:03,120 --> 00:25:05,200 How do you feel, having just had a snack? 455 00:25:05,200 --> 00:25:06,480 - Do you feel all right? - Yeah. 456 00:25:06,480 --> 00:25:09,440 You seem more relaxed, suddenly. 457 00:25:09,440 --> 00:25:10,760 - Yeah. - Right now. 458 00:25:10,760 --> 00:25:11,800 What's that about? 459 00:25:12,920 --> 00:25:14,920 Because... 460 00:25:14,920 --> 00:25:17,960 I think I know I've had it and I've had it at the right time and 461 00:25:17,960 --> 00:25:20,680 - everything like that. - Where you getting tense before 462 00:25:20,680 --> 00:25:21,800 because of the snack? 463 00:25:21,800 --> 00:25:24,720 I worry mainly for my measurements that it's the right... 464 00:25:24,720 --> 00:25:27,920 - That it's enough. - Are you worried about having too much or too little? 465 00:25:27,920 --> 00:25:29,240 Too little. 466 00:25:31,880 --> 00:25:36,720 Given that, basically, the idea is for you to put weight on, 467 00:25:36,720 --> 00:25:39,200 you could have extra and it certainly wouldn't 468 00:25:39,200 --> 00:25:41,440 get you into trouble, but there's something in you 469 00:25:41,440 --> 00:25:43,160 - that's stopping that. - Yeah. 470 00:25:45,800 --> 00:25:48,920 Rosie's anorexia had afflicted the entire family. 471 00:25:50,560 --> 00:25:53,560 Even with Rosie seemingly doing well in recovery, 472 00:25:53,560 --> 00:25:56,640 the illness and its demands were still a daily struggle 473 00:25:56,640 --> 00:25:58,120 for all of them. 474 00:26:03,600 --> 00:26:07,440 One of the most striking features of anorexia is the difficulty many 475 00:26:07,440 --> 00:26:10,840 patients have in seeing themselves as ill. 476 00:26:10,840 --> 00:26:13,200 I feel that people are judging me by 477 00:26:13,200 --> 00:26:15,880 my body and looking at me and thinking, 478 00:26:15,880 --> 00:26:17,520 "Oh, what is she doing here? 479 00:26:17,520 --> 00:26:20,000 "She's too fat to be here. 480 00:26:20,000 --> 00:26:21,960 "Why? What the hell is she doing here?" 481 00:26:23,480 --> 00:26:26,800 Many of those in inpatient treatment are there against their will. 482 00:26:28,120 --> 00:26:30,120 Among them, was Ifzana. 483 00:26:30,120 --> 00:26:31,640 - Hiya. - Hello. 484 00:26:31,640 --> 00:26:32,720 Hi, Rosie. How are you? 485 00:26:32,720 --> 00:26:34,880 Nice to see you. Hi, Ifzana, how are you? 486 00:26:34,880 --> 00:26:37,520 I'm OK, thank you. 487 00:26:37,520 --> 00:26:39,960 You've done my bloods before, you usually get it in one. 488 00:26:39,960 --> 00:26:42,880 - You're really good at it. - Now you're going to give it bad luck, though. 489 00:26:42,880 --> 00:26:44,760 No pressure! 490 00:26:44,760 --> 00:26:46,480 That looks good. 491 00:26:46,480 --> 00:26:48,240 She's really good at taking blood. 492 00:26:50,720 --> 00:26:52,920 An assistant in an operating theatre, 493 00:26:52,920 --> 00:26:55,960 Ifzana had been brought into Phoenix Wing two weeks earlier, 494 00:26:55,960 --> 00:26:58,480 after being sectioned. 495 00:26:58,480 --> 00:27:01,880 It was her third round of residential treatment. 496 00:27:01,880 --> 00:27:06,240 When did people start noticing that you had an issue around food? 497 00:27:06,240 --> 00:27:09,640 I've had it probably about five years. 498 00:27:09,640 --> 00:27:12,400 I was at a much, much lower weight. 499 00:27:12,400 --> 00:27:16,200 My ECG, yeah, it kind of basically looked similar to someone 500 00:27:16,200 --> 00:27:18,680 who'd had a heart attack. 501 00:27:21,160 --> 00:27:23,560 It sounded like you nearly died. 502 00:27:23,560 --> 00:27:27,760 Yeah. Even now when they say that, part of me's a bit like, 503 00:27:27,760 --> 00:27:30,200 "Oh, you guys are just being melodramatic," but... 504 00:27:30,200 --> 00:27:33,920 I don't want to dwell on it too much because they're going to obviously stick to 505 00:27:33,920 --> 00:27:36,200 their opinion, I'm going to stick to my mine. 506 00:27:36,200 --> 00:27:37,680 We're not going to move any way. 507 00:27:40,120 --> 00:27:44,160 - You wanted to leave. - Yes. - Even when you were in hospital, nearly dying? 508 00:27:46,960 --> 00:27:48,360 Does that seem odd to you? 509 00:27:48,360 --> 00:27:51,280 I guess because I couldn't physically feel it... 510 00:27:51,280 --> 00:27:52,960 Could you see it in the mirror? 511 00:27:52,960 --> 00:27:55,200 - No. - You thought you looked fine? 512 00:27:55,200 --> 00:27:56,480 Yeah. 513 00:27:59,920 --> 00:28:03,520 Do you accept that you have anorexia? 514 00:28:03,520 --> 00:28:08,120 I guess. Obviously, if I had to go into an inpatient hospital 515 00:28:08,120 --> 00:28:12,240 for nine months in Cambridge and then come out and then go back 516 00:28:12,240 --> 00:28:16,120 into hospital, then there was obviously a reason for it. 517 00:28:18,320 --> 00:28:20,560 You were sectioned to come here. 518 00:28:20,560 --> 00:28:23,000 - Uh-hm. - If you hadn't been, would you be here? - No. 519 00:28:27,440 --> 00:28:30,800 - OK, thank you very much. - You're welcome. - Thanks. 520 00:28:32,600 --> 00:28:33,800 Wish me luck. 521 00:28:37,960 --> 00:28:39,800 How old are you? 522 00:28:39,800 --> 00:28:41,400 I like when people guess. 523 00:28:43,040 --> 00:28:44,440 Well, sometimes I do. 524 00:28:50,560 --> 00:28:51,800 Don't think so hard. 525 00:28:52,800 --> 00:28:54,440 You're 23. 526 00:28:54,440 --> 00:28:57,520 How the hell do you know? You probably saw my notes beforehand 527 00:28:57,520 --> 00:28:59,040 - or something. - No. Are you 23? 528 00:28:59,040 --> 00:29:00,560 I'll be 24 in July. 529 00:29:01,840 --> 00:29:03,400 God, I feel old. 530 00:29:08,280 --> 00:29:10,120 Hi, sorry to keep you waiting. 531 00:29:10,120 --> 00:29:12,640 - No problem. - Do you want to come in? - Yes. 532 00:29:12,640 --> 00:29:16,440 I was joining Ifzana for her fortnightly review. 533 00:29:16,440 --> 00:29:19,560 She had requested leave from the ward. 534 00:29:19,560 --> 00:29:23,040 I was hoping this weekend, either get Saturday and Sunday, 535 00:29:23,040 --> 00:29:27,360 one to three on both days or on one day, one to five. 536 00:29:27,360 --> 00:29:29,480 In terms of the leave, then, 537 00:29:29,480 --> 00:29:31,920 I think what you need to do is go out in the wheelchair. 538 00:29:31,920 --> 00:29:33,880 Oh, no, we're not going back to that. 539 00:29:33,880 --> 00:29:37,120 - Yeah. - No. - I think, Ifzana, just because we want to minimise 540 00:29:37,120 --> 00:29:40,000 the activity level and because of the low blood pressure. 541 00:29:40,000 --> 00:29:41,200 We're going to be looking... 542 00:29:41,200 --> 00:29:43,920 But that's what I'm saying, to do my blood pressure beforehand. 543 00:29:43,920 --> 00:29:46,000 OK, if it's low, then I'll go out in the wheelchair, 544 00:29:46,000 --> 00:29:48,840 but I don't want to be told, yeah, you're going out in the wheelchair, 545 00:29:48,840 --> 00:29:51,880 because if it isn't low, then I feel like... 546 00:29:51,880 --> 00:29:54,840 Is it to minimise activity and therefore not too many calories 547 00:29:54,840 --> 00:29:57,600 - are getting burned? - That's right, yes. 548 00:29:57,600 --> 00:30:01,440 It's not that you think Ifzana necessarily is going to keel over. 549 00:30:01,440 --> 00:30:05,320 No, it's partly because of the low blood pressure but I think that's 550 00:30:05,320 --> 00:30:10,760 getting better. But partly it is because of activity levels. 551 00:30:10,760 --> 00:30:13,320 What we want to do is we want to limit that as much as possible 552 00:30:13,320 --> 00:30:15,560 - so that is... - Yes, but yesterday I went for my leave, 553 00:30:15,560 --> 00:30:19,760 and I went without the wheelchair and my weight still went up 554 00:30:19,760 --> 00:30:21,000 so I think... 555 00:30:21,000 --> 00:30:23,720 I've been here before, so I think there should be a level of trust. 556 00:30:23,720 --> 00:30:26,560 What we could also do is have a look at sort of how the blood pressure 557 00:30:26,560 --> 00:30:28,080 goes sort of today, 558 00:30:28,080 --> 00:30:30,720 tomorrow and Wednesday in terms of how things are looking. 559 00:30:30,720 --> 00:30:32,600 OK, fine. And we'll do that, as well. 560 00:30:37,240 --> 00:30:41,400 Ifzana had also been attempting to burn calories by standing. 561 00:30:42,520 --> 00:30:44,360 Would you like to take a seat? 562 00:30:44,360 --> 00:30:48,280 - Not really. - They did say you should sit down more. 563 00:30:48,280 --> 00:30:49,520 Yeah, they say a lot of things. 564 00:30:49,520 --> 00:30:51,120 You don't want to sit down? 565 00:30:51,120 --> 00:30:53,880 - No. - Do you want to try? 566 00:30:53,880 --> 00:30:55,240 I can sit down. 567 00:30:55,240 --> 00:30:56,520 Let's see what happens. 568 00:30:56,520 --> 00:30:58,040 Nothing's going to happen. 569 00:30:58,040 --> 00:30:59,600 I sat down at snack. 570 00:30:59,600 --> 00:31:01,080 Do it now and see how it feels. 571 00:31:01,080 --> 00:31:02,440 - No. - Just for a second. 572 00:31:03,480 --> 00:31:04,720 Here. 573 00:31:08,160 --> 00:31:10,560 - Stay sitting down. - You said a second! 574 00:31:11,640 --> 00:31:12,840 Now for ten seconds. 575 00:31:17,760 --> 00:31:20,000 How does that feel now? 576 00:31:20,000 --> 00:31:23,360 I know, short term, it doesn't really feel like anything. 577 00:31:23,360 --> 00:31:25,600 It kind of feels like an inconvenience, to be honest. 578 00:31:28,160 --> 00:31:30,080 What are you doing? You look uncomfortable. 579 00:31:30,080 --> 00:31:31,560 I'm just trying to... 580 00:31:31,560 --> 00:31:32,840 HE CLEARS THROAT 581 00:31:32,840 --> 00:31:35,360 - Do you want to sit down again? - No. 582 00:31:35,360 --> 00:31:38,320 I'm not an animal or a... 583 00:31:38,320 --> 00:31:39,800 I have to jump through their hoops, 584 00:31:39,800 --> 00:31:42,360 I'm not going to jump through yours, as well! 585 00:31:52,080 --> 00:31:54,520 I have the impression she's not really sure 586 00:31:54,520 --> 00:31:56,680 whether she really has the illness. 587 00:31:56,680 --> 00:32:00,200 I mean, that's not sort of uncommon with a lot of our patients, 588 00:32:00,200 --> 00:32:04,280 in that they... On some level, they can see that they're unwell, 589 00:32:04,280 --> 00:32:06,680 but on other levels it's quite difficult for them to. 590 00:32:06,680 --> 00:32:09,520 Or even if, maybe, she accepts she has got the illness, 591 00:32:09,520 --> 00:32:13,400 but perhaps she'd just...like to have the illness. 592 00:32:13,400 --> 00:32:15,840 We'd always encourage people to go for recovery, 593 00:32:15,840 --> 00:32:18,040 but if it's too difficult, what we say is, right, OK, 594 00:32:18,040 --> 00:32:19,360 let's go somewhere in between. 595 00:32:19,360 --> 00:32:22,680 You don't give up the eating disorder because you need it for whatever reason. 596 00:32:22,680 --> 00:32:26,440 It's a way of managing something and so we help you just manage things in 597 00:32:26,440 --> 00:32:29,320 the community, so you can actually have some sort of quality of life. 598 00:32:29,320 --> 00:32:33,000 So, with Ifzana, strictly speaking, you're not aiming 599 00:32:33,000 --> 00:32:36,240 - for a full recovery. - No. 600 00:32:36,240 --> 00:32:39,360 That's because Ifzana doesn't want that at the moment. 601 00:32:39,360 --> 00:32:42,560 If you did nothing at all, if there was no treatment whatsoever, 602 00:32:42,560 --> 00:32:43,920 what would happen? 603 00:32:43,920 --> 00:32:47,200 I think there'd be a very high risk of death, essentially. 604 00:32:51,120 --> 00:32:55,560 I began to settle into the routine of life in the clinics. 605 00:32:55,560 --> 00:32:58,600 We've got cottage pie or we've got vegetarian cottage pie. 606 00:32:58,600 --> 00:33:00,320 I'll try the veg, the vegetarian. 607 00:33:02,600 --> 00:33:05,680 It was baffling to find people seemingly so insightful 608 00:33:05,680 --> 00:33:08,520 and full of promise who were, at the same time, 609 00:33:08,520 --> 00:33:11,600 in the grip of something so irrational. 610 00:33:11,600 --> 00:33:13,360 - How are you doing? - Yeah, not bad. 611 00:33:13,360 --> 00:33:15,680 Especially when it's hot, but there you go. 612 00:33:17,320 --> 00:33:20,760 Making it all the more strange was the way patients valued 613 00:33:20,760 --> 00:33:24,640 and held on to symptoms that could end up killing them. 614 00:33:24,640 --> 00:33:29,240 While recovery was nearly always viewed with ambivalence and fear. 615 00:33:29,240 --> 00:33:31,440 I've never cooked in my life. 616 00:33:31,440 --> 00:33:32,800 You're cooking right now. 617 00:33:34,000 --> 00:33:37,360 Despite the support of clinical staff and families, 618 00:33:37,360 --> 00:33:41,360 it was hard to see how patients would ever break the cycle. 619 00:33:41,360 --> 00:33:44,880 Once I leave hospital, give me long enough and eventually things will 620 00:33:44,880 --> 00:33:46,840 start going backwards. 621 00:33:49,200 --> 00:33:52,280 At Phoenix Wing, change was in the air. 622 00:33:52,280 --> 00:33:55,120 Rosie had let me know she would be making an announcement 623 00:33:55,120 --> 00:33:56,840 in her fortnightly review. 624 00:33:58,640 --> 00:34:01,880 - Hello. - Buongiorno! How's it going? 625 00:34:01,880 --> 00:34:03,920 - Very well. Yourself? - Good to see you. 626 00:34:03,920 --> 00:34:05,480 - You, too. - Light hug? 627 00:34:05,480 --> 00:34:06,960 Very light, distant? 628 00:34:06,960 --> 00:34:08,640 - There we go. - There you go. 629 00:34:08,640 --> 00:34:10,880 Feel like it's been a while. 630 00:34:10,880 --> 00:34:12,920 Yeah. How you doing? 631 00:34:12,920 --> 00:34:15,640 OK. I've been waiting for this all day, so, yeah... 632 00:34:15,640 --> 00:34:19,120 - Have you? - Yeah. - Do you like your ward rounds? 633 00:34:19,120 --> 00:34:21,000 When I get a good outcome, yeah. 634 00:34:21,000 --> 00:34:23,880 If I don't, then you'll see. 635 00:34:23,880 --> 00:34:29,200 - Do you know what they're going to say? - Erm, not really. 636 00:34:29,200 --> 00:34:30,640 A bit anxious. 637 00:34:30,640 --> 00:34:33,160 And you've submitted in writing... 638 00:34:33,160 --> 00:34:37,240 - Yeah. - ..a rough sense of what's on your agenda. 639 00:34:37,240 --> 00:34:41,560 Yeah. Yeah. So I'm just worried about the outcome. 640 00:34:41,560 --> 00:34:43,120 Hope it's all positive, I really do. 641 00:34:43,120 --> 00:34:45,760 - What's on your agenda? - That'd be telling, wouldn't it? 642 00:34:45,760 --> 00:34:47,320 You'll have to wait and see. 643 00:34:48,880 --> 00:34:50,600 - Oh, I like it. - Yeah. 644 00:34:50,600 --> 00:34:52,160 I love surprises. 645 00:34:52,160 --> 00:34:53,240 Yeah. 646 00:34:53,240 --> 00:34:54,600 Hello. 647 00:34:58,200 --> 00:35:01,560 Right, so, yeah, so your ward round... 648 00:35:01,560 --> 00:35:05,440 - So let's go through the points. - What I wanted to discuss with you... 649 00:35:06,960 --> 00:35:11,360 ..is immediate discharge into a well-equipped environment 650 00:35:11,360 --> 00:35:15,840 and a supportive family and work with the outpatient services 651 00:35:15,840 --> 00:35:19,720 and also continue my family therapy, as I find it very proactive 652 00:35:19,720 --> 00:35:23,360 and helpful. Sorry... 653 00:35:28,000 --> 00:35:29,960 I do worry about immediate discharge, 654 00:35:29,960 --> 00:35:31,760 if I'm completely honest with you. 655 00:35:31,760 --> 00:35:33,440 You are informal. 656 00:35:33,440 --> 00:35:36,480 This is... I would say, if we discharge you today, 657 00:35:36,480 --> 00:35:38,120 it's against medical advice. 658 00:35:40,360 --> 00:35:44,520 Rosie had decided she was done with inpatient treatment, 659 00:35:44,520 --> 00:35:46,280 but the clinical staff were concerned 660 00:35:46,280 --> 00:35:48,960 that as someone still relatively new to the illness, 661 00:35:48,960 --> 00:35:51,120 she was more unwell than she realised. 662 00:35:52,880 --> 00:35:55,160 You've just decided you've had enough, haven't you? 663 00:35:55,160 --> 00:35:59,080 I have. I just don't belong here any more. 664 00:35:59,080 --> 00:36:02,880 Maybe you don't think you really have an eating disorder. 665 00:36:02,880 --> 00:36:04,720 I feel like I've overcome it. 666 00:36:06,040 --> 00:36:08,680 That could be the anorexia telling you that. 667 00:36:09,800 --> 00:36:14,360 I think at this stage it isn't, it's me. 668 00:36:21,800 --> 00:36:25,640 The following morning, it emerged that staff had decided not to grant 669 00:36:25,640 --> 00:36:29,240 Rosie's discharge, but instead give her an extended leave. 670 00:36:45,200 --> 00:36:46,640 I know. 671 00:36:46,640 --> 00:36:48,360 Shhhh. 672 00:36:50,600 --> 00:36:52,240 ROSIE SOBS 673 00:36:52,240 --> 00:36:53,880 Come on. 674 00:36:53,880 --> 00:36:55,360 Don't get upset. 675 00:36:59,640 --> 00:37:04,520 It did take us by surprise yesterday that Rosie wished to self-discharge, 676 00:37:04,520 --> 00:37:08,720 so what I have done is I've gone back to the notes 677 00:37:08,720 --> 00:37:14,880 and just to kind of follow her, kind of... How she coped with the leave. 678 00:37:14,880 --> 00:37:18,840 And since May, it felt that the home leave... 679 00:37:18,840 --> 00:37:20,920 She has consistently lost weight. 680 00:37:23,200 --> 00:37:26,080 Based on what I've seen here, I don't feel 681 00:37:26,080 --> 00:37:28,520 that you're ready for discharge. 682 00:37:30,520 --> 00:37:34,520 I couldn't help but empathise with Rosie, denied her freedom 683 00:37:34,520 --> 00:37:39,000 but also with the clinical team put in the position of making decisions 684 00:37:39,000 --> 00:37:42,720 in the interests of patients but against their will. 685 00:37:42,720 --> 00:37:45,240 Can I take that, the advice that we've given, 686 00:37:45,240 --> 00:37:48,320 this medical recommendation is something that you are in agreement 687 00:37:48,320 --> 00:37:51,280 - with at the moment? - I feel like I have no choice. 688 00:37:55,560 --> 00:37:58,680 It looks from the beginning of May that she has been 689 00:37:58,680 --> 00:38:02,800 consistently losing the weight and the weight that she has managed... 690 00:38:02,800 --> 00:38:04,280 - At home? - At home, yeah. 691 00:38:04,280 --> 00:38:07,240 It is very apparent that, you know, overnight leave is a problem 692 00:38:07,240 --> 00:38:09,680 and it doesn't feel that she has mastered it. 693 00:38:09,680 --> 00:38:13,480 She has managed shorter periods of leave but not the longer one. 694 00:38:13,480 --> 00:38:14,760 These big decisions, 695 00:38:14,760 --> 00:38:17,000 we have to think about them very, very carefully. 696 00:38:17,000 --> 00:38:20,760 And I feel there will be sufficient grounds to say that, 697 00:38:20,760 --> 00:38:23,000 if she did insist to leave, 698 00:38:23,000 --> 00:38:27,240 it can be that we will get a second opinion from a mental health... 699 00:38:27,240 --> 00:38:29,280 I haven't said that because Rosie did agree. 700 00:38:29,280 --> 00:38:31,320 - You mean a section? - Yeah. 701 00:38:31,320 --> 00:38:34,840 So basically if she's resisting - "I don't care what you think, 702 00:38:34,840 --> 00:38:36,320 "I'm still going home." 703 00:38:36,320 --> 00:38:39,640 You would seriously consider getting a section? 704 00:38:39,640 --> 00:38:41,720 - Yeah. - Initiating the process. 705 00:38:41,720 --> 00:38:44,480 - Yeah, yeah. - Yeah. Big decision. 706 00:38:44,480 --> 00:38:49,480 I suspect whether there is a fear of continuing recovery, 707 00:38:49,480 --> 00:38:52,160 whether there's a realisation that it's not as easy 708 00:38:52,160 --> 00:38:53,480 as I thought it would be. 709 00:38:54,960 --> 00:38:58,760 Rosie's apparent confidence that she was well again, spoke to what 710 00:38:58,760 --> 00:39:02,280 may be anorexia's most insidious characteristic. 711 00:39:02,280 --> 00:39:05,240 How it hijacks patients' thinking, 712 00:39:05,240 --> 00:39:08,320 tricking them into allowing it control of their lives 713 00:39:08,320 --> 00:39:11,720 and their decisions and making recovery elusive. 714 00:39:19,360 --> 00:39:20,400 Thank you. 715 00:39:21,520 --> 00:39:25,400 At Vincent Square, I discovered Jess was in difficulties. 716 00:39:25,400 --> 00:39:28,560 - How's it going? - All right, a bit stressful. 717 00:39:29,840 --> 00:39:32,800 I think you're going to do some medical stuff with Aki, 718 00:39:32,800 --> 00:39:36,240 - and then we'll take it from there. - Ready? - Yeah. - OK, sure. 719 00:39:36,240 --> 00:39:39,840 Despite the 12 hours a day of being fed and monitored as a 720 00:39:39,840 --> 00:39:43,080 day patient on the unit, she was still losing weight. 721 00:39:44,200 --> 00:39:47,720 It had been decided she needed to come back into full-time care. 722 00:39:49,200 --> 00:39:52,760 - How are you feeling today? - Erm... 723 00:39:53,800 --> 00:39:58,560 Quite stressed. I'm just feeling a bit despondent 724 00:39:58,560 --> 00:40:00,840 that I'm doing this again. 725 00:40:00,840 --> 00:40:04,360 Feels like maybe you're not making progress? 726 00:40:04,360 --> 00:40:07,200 I just feel a bit embarrassed, like I've failed, really. 727 00:40:11,240 --> 00:40:14,880 She's somebody who has been ill for an incredibly long time. 728 00:40:14,880 --> 00:40:19,120 She's had lots of admissions to hospital and every time she leaves hospital, 729 00:40:19,120 --> 00:40:22,000 she loses weight really fast and really dramatically. 730 00:40:23,400 --> 00:40:25,200 Recovery takes a long time. 731 00:40:25,200 --> 00:40:29,200 People often have to go round and round more than once, 732 00:40:29,200 --> 00:40:32,000 through loops of, you know, restoring weight, 733 00:40:32,000 --> 00:40:34,680 having a go at losing, coming back round again 734 00:40:34,680 --> 00:40:37,480 before something works that helps them move on. 735 00:40:37,480 --> 00:40:42,160 Right, Jess. How do you feel about doing a squat for me? 736 00:40:42,160 --> 00:40:44,280 - Do you think you can do that? - Yeah. 737 00:40:46,400 --> 00:40:47,720 And back up. 738 00:40:48,760 --> 00:40:49,920 Well done. 739 00:40:55,120 --> 00:40:58,400 This past week, as I understand it, you've lost more weight. 740 00:40:58,400 --> 00:41:00,240 Do you think that's because you 741 00:41:00,240 --> 00:41:02,640 knew you were coming back in, in some way? 742 00:41:02,640 --> 00:41:06,800 You kind of start thinking there's no point in fighting 743 00:41:06,800 --> 00:41:09,120 because you know you're going to be, like... 744 00:41:10,560 --> 00:41:15,000 Force fed and have to eat loads of really scary foods and stuff 745 00:41:15,000 --> 00:41:20,720 and it's just, like, why put myself through the pain of forcing myself 746 00:41:20,720 --> 00:41:23,320 to eat, when I know what's coming? 747 00:41:23,320 --> 00:41:28,240 There's a safety net, almost like someone going in to alcohol rehab. 748 00:41:28,240 --> 00:41:31,760 In the week leading up, they're going to get as drunk as they can. 749 00:41:31,760 --> 00:41:33,600 As a last hurrah, almost. 750 00:41:36,480 --> 00:41:39,480 It takes a hell of a lot more strength to eat 751 00:41:39,480 --> 00:41:42,440 and recover from this illness, than 752 00:41:42,440 --> 00:41:45,760 it does, for me anyway, to indulge in it. 753 00:41:51,680 --> 00:41:54,760 This would be Jess's eighth stay as an inpatient. 754 00:41:58,440 --> 00:42:00,880 I'm really sorry that it's been such a struggle. 755 00:42:04,080 --> 00:42:05,680 I just feel like I need a break. 756 00:42:07,000 --> 00:42:09,040 Just some time out to clear my head. 757 00:42:11,480 --> 00:42:13,360 Sounds like you're struggling a bit. 758 00:42:18,520 --> 00:42:19,920 What's in your head? 759 00:42:25,040 --> 00:42:29,320 It's just so hard having to eat and deal with the feelings that that 760 00:42:29,320 --> 00:42:32,520 brings up and not have my usual ways of coping. 761 00:42:34,000 --> 00:42:38,360 And do you feel you are committed to your recovery? 762 00:42:38,360 --> 00:42:41,080 It kind of ebbs and flows at times. 763 00:42:42,200 --> 00:42:45,000 Like, I know I hate this illness, I hate my life at the moment, 764 00:42:45,000 --> 00:42:48,480 but I just don't really believe that I can recover. 765 00:42:53,440 --> 00:42:55,840 - I mean, are you OK? - Yeah, I'm OK. 766 00:42:55,840 --> 00:42:59,960 I just... I'm so sorry that you're going through this. 767 00:42:59,960 --> 00:43:01,280 Thank you. 768 00:43:07,680 --> 00:43:11,040 Jess has had this disorder for a long time now. 769 00:43:11,040 --> 00:43:14,560 How realistic is recovery? 770 00:43:14,560 --> 00:43:16,320 Part of what's difficult for Jess, 771 00:43:16,320 --> 00:43:19,920 part of the snag that pulls her back is the world's now quite a scary 772 00:43:19,920 --> 00:43:22,440 place. And you can kind of relate to that. 773 00:43:22,440 --> 00:43:26,120 If you think, if you've lived a lot of your life in and out of hospital, 774 00:43:26,120 --> 00:43:28,320 people telling you what to do all the time, 775 00:43:28,320 --> 00:43:31,080 your illness telling you what to do all the time, 776 00:43:31,080 --> 00:43:34,920 she's missed out on a lot of the normal development opportunities 777 00:43:34,920 --> 00:43:38,640 through which you kind of learn to feel more confident in yourself 778 00:43:38,640 --> 00:43:42,200 and how you manage the world. I don't think she's somebody who, 779 00:43:42,200 --> 00:43:45,200 she's going to come into hospital and this episode of admission 780 00:43:45,200 --> 00:43:47,720 is going to be, that's it, boom and she's suddenly recovered 781 00:43:47,720 --> 00:43:49,840 and everything's OK. 782 00:43:49,840 --> 00:43:54,440 I do think that this admission can contribute to her journey 783 00:43:54,440 --> 00:43:57,360 of getting to a place from which she can recover. 784 00:44:14,760 --> 00:44:17,280 It had been four weeks since I'd last seen Ifzana. 785 00:44:18,480 --> 00:44:20,640 In spite of the fact she was still sectioned, 786 00:44:20,640 --> 00:44:22,920 she seemed to be more engaged with her treatment. 787 00:44:22,920 --> 00:44:24,520 - Hiya. - Hello. 788 00:44:27,640 --> 00:44:29,520 How are you doing? 789 00:44:29,520 --> 00:44:32,800 OK, how are you? Been busy? 790 00:44:32,800 --> 00:44:35,600 - Yeah. - How's everything, have you had your hair cut? 791 00:44:35,600 --> 00:44:38,240 - Yeah. - See, I notice things. 792 00:44:39,520 --> 00:44:41,280 - Have you had a haircut? - No. 793 00:44:42,400 --> 00:44:45,520 But I changed it because it's, like, really hot, 794 00:44:45,520 --> 00:44:47,360 so it leaves my neck a bit cooler. 795 00:44:49,000 --> 00:44:50,880 What do you think of the banana drink? 796 00:44:51,920 --> 00:44:53,240 It's just a banana drink. 797 00:44:57,320 --> 00:44:58,720 What do you think of it? 798 00:45:01,120 --> 00:45:03,000 It's neither hot nor cold. 799 00:45:03,000 --> 00:45:05,080 SHE SNIGGERS 800 00:45:05,080 --> 00:45:10,400 - Don't tell that to the staff(!) - What is it supposed to be? - It's hot. 801 00:45:10,400 --> 00:45:13,320 - It's supposed to be hot? - Did you ask for it hot? 802 00:45:13,320 --> 00:45:16,080 I didn't really... I just said, "Give me what Ifzana's having." 803 00:45:16,080 --> 00:45:17,920 Well, then, it's supposed to be hot. 804 00:45:21,800 --> 00:45:24,480 I suppose I should just be grateful to have anything. 805 00:45:28,760 --> 00:45:31,920 I was curious to know if Ifzana was now more on board 806 00:45:31,920 --> 00:45:34,640 with the idea of being well. 807 00:45:34,640 --> 00:45:36,640 How do you feel you're doing? 808 00:45:36,640 --> 00:45:38,880 I definitely think things are moving forward. 809 00:45:38,880 --> 00:45:40,200 In what way? 810 00:45:40,200 --> 00:45:43,000 Well, obviously physically, my weight is obviously going up. 811 00:45:43,000 --> 00:45:46,360 Is it? I mean, you say, "obviously", I'm no expert but... 812 00:45:47,840 --> 00:45:50,600 And without prying in any way, so it is... 813 00:45:50,600 --> 00:45:52,560 You're sort of getting weighed regularly 814 00:45:52,560 --> 00:45:54,040 and they tell you it's going up, 815 00:45:54,040 --> 00:45:56,280 - is that right? - They don't exactly tell you. 816 00:45:56,280 --> 00:45:58,080 I kind of can see from the scales. 817 00:45:58,080 --> 00:45:59,520 - They show you the numbers. - Yeah. 818 00:45:59,520 --> 00:46:01,800 And how do you feel about the numbers going up? 819 00:46:01,800 --> 00:46:04,120 Well, I guess I'm always in two minds. 820 00:46:04,120 --> 00:46:07,800 The eating disorder part of me is obviously not thrilled, 821 00:46:07,800 --> 00:46:09,920 but the other side of me knows that it has to 822 00:46:09,920 --> 00:46:11,680 and I don't really have a choice. 823 00:46:14,720 --> 00:46:17,280 Ifzana had told me she'd been bullied as a child 824 00:46:17,280 --> 00:46:20,920 and that a few years earlier, she'd refused an arranged marriage. 825 00:46:22,160 --> 00:46:25,240 I wondered if she felt either experience had played a role 826 00:46:25,240 --> 00:46:28,320 in her illness, or whether the causes were more obscure. 827 00:46:29,920 --> 00:46:31,840 Where do you think it comes from? 828 00:46:31,840 --> 00:46:33,720 I think it's a mixture of things. 829 00:46:33,720 --> 00:46:35,080 SHE SNIFFLES 830 00:46:36,800 --> 00:46:39,480 I don't think there's one definite sort of pinpoint. 831 00:46:41,880 --> 00:46:44,000 Are you all right? I haven't made you upset, have I? 832 00:46:44,000 --> 00:46:45,760 - No, it's fine. - Have you got the sniffles? 833 00:46:45,760 --> 00:46:47,640 - Yeah, a bit. - Thinking about what? 834 00:46:53,000 --> 00:46:54,200 Everything changes. 835 00:46:54,200 --> 00:46:56,760 Everything... I usually don't like reflecting on things, 836 00:46:56,760 --> 00:46:58,560 especially with this whole process. 837 00:46:58,560 --> 00:47:01,880 It's kind of like... Because it obviously makes me upset and I can't 838 00:47:01,880 --> 00:47:04,520 - control it. - Oh... I'm sorry. 839 00:47:11,080 --> 00:47:13,560 - I'm really sorry. - It's not your fault. 840 00:47:27,680 --> 00:47:31,120 You are choosing to be here and I think you staying here 841 00:47:31,120 --> 00:47:34,640 is a kind of victory. I mean, I know you've got all different... 842 00:47:36,840 --> 00:47:40,400 ..thoughts in your head, pulling you in different directions, but... 843 00:47:40,400 --> 00:47:45,280 Looked at in the healthy way, you're doing really well. 844 00:47:50,040 --> 00:47:52,240 The disorder's pulling you back, isn't it? 845 00:47:53,960 --> 00:47:55,800 There's a part of you telling you... 846 00:47:57,440 --> 00:47:59,560 ..that you don't really want recovery. 847 00:48:01,680 --> 00:48:05,040 - And telling you that it feels wrong. - Yeah. 848 00:48:10,840 --> 00:48:14,280 One of the paradoxes of physical recovery from anorexia 849 00:48:14,280 --> 00:48:17,640 is that it can lead patients to feel worse. 850 00:48:17,640 --> 00:48:20,040 No longer numb, they have to face emotions 851 00:48:20,040 --> 00:48:22,360 they had suppressed by starvation. 852 00:48:23,440 --> 00:48:25,520 Often, this leads to relapse. 853 00:48:31,280 --> 00:48:34,640 The average recovery time from anorexia is seven years. 854 00:48:34,640 --> 00:48:35,960 Hello. 855 00:48:37,520 --> 00:48:39,640 It's hot out there, isn't it? Nice to see you. 856 00:48:39,640 --> 00:48:42,600 - How's it going? - OK. And you? 857 00:48:42,600 --> 00:48:44,040 Good. 858 00:48:44,040 --> 00:48:46,120 In the 40 years Janet had been ill, 859 00:48:46,120 --> 00:48:49,520 she'd never managed full recovery. 860 00:48:49,520 --> 00:48:53,560 - Hi, I'm Sophie. - Nice to meet you. - Nice to meet you. 861 00:48:53,560 --> 00:48:56,840 Hoping for some insight into why she'd found it so hard, 862 00:48:56,840 --> 00:48:59,600 I was joining her for a therapy session, 863 00:48:59,600 --> 00:49:01,880 which started with a weigh-in. 864 00:49:01,880 --> 00:49:03,640 - OK. - I've done well, haven't I? 865 00:49:03,640 --> 00:49:04,920 You've done very well. 866 00:49:06,320 --> 00:49:07,680 So you put a little bit on? 867 00:49:07,680 --> 00:49:10,400 Yeah, I'm not happy, so now I feel like I have to starve myself. 868 00:49:12,880 --> 00:49:14,200 I'm not happy. 869 00:49:14,200 --> 00:49:18,160 - I don't know why I've put on... - But it's - ..loads, haven't I? 870 00:49:18,160 --> 00:49:20,400 Not loads, Janet, but I think this is... 871 00:49:20,400 --> 00:49:23,040 - I have! I was... - This is very reflective, isn't it, 872 00:49:23,040 --> 00:49:27,000 of the two parts of you that we kind of identified? 873 00:49:27,000 --> 00:49:29,640 The part of you that wants this to get better 874 00:49:29,640 --> 00:49:32,960 and the part of you that's really anxious about that. 875 00:49:32,960 --> 00:49:35,000 From your experience in this field, 876 00:49:35,000 --> 00:49:39,680 do you have any sense of where this problem is coming from? 877 00:49:39,680 --> 00:49:43,080 I think, for Janet, this started a long, long time ago, 878 00:49:43,080 --> 00:49:46,880 at a time where maybe Janet felt she needed some control over something. 879 00:49:46,880 --> 00:49:49,080 I mean, Janet, would you agree with that? 880 00:49:49,080 --> 00:49:52,360 - 100%, yeah. - Control, why were you looking for control? 881 00:49:52,360 --> 00:49:54,680 Because I couldn't control anything else... 882 00:49:54,680 --> 00:49:56,040 In your life? 883 00:49:56,040 --> 00:49:57,640 - Why? - In my religion. 884 00:49:57,640 --> 00:50:01,040 I'm Jewish and in my religion in those days, 30 years ago, 885 00:50:01,040 --> 00:50:06,200 40 years ago, you had to get married young, have children and do well. 886 00:50:06,200 --> 00:50:07,760 I didn't want to get married. 887 00:50:07,760 --> 00:50:10,200 I didn't want to grow up, I wanted to be a child. 888 00:50:10,200 --> 00:50:13,280 I was terrified of going to work, terrified of leaving home. 889 00:50:13,280 --> 00:50:15,120 It all scared me so much. 890 00:50:15,120 --> 00:50:17,960 The anorexia was my best friend because I didn't have to do anything 891 00:50:17,960 --> 00:50:19,400 because I was sick all the time. 892 00:50:19,400 --> 00:50:22,520 It was my own little world that I could hide inside. 893 00:50:22,520 --> 00:50:24,560 I think there's probably a lot in that. 894 00:50:24,560 --> 00:50:27,720 It's come from my gut. Not all this psychological stuff. 895 00:50:27,720 --> 00:50:29,760 You just do not want to grow up. 896 00:50:29,760 --> 00:50:31,560 You're just too scared. 897 00:50:31,560 --> 00:50:33,840 You can't cope, end of. 898 00:50:35,640 --> 00:50:40,400 - Maybe the fact that I want to tell you to eat... - You're frustrated. 899 00:50:40,400 --> 00:50:43,120 I'm sort of, I feel like maybe that's another way... 900 00:50:43,120 --> 00:50:45,200 Maybe that in some level... 901 00:50:45,200 --> 00:50:48,000 - You're frustrated. - Is that how you want me to respond, maybe? 902 00:50:49,040 --> 00:50:50,960 So that I'm like a parent to you. 903 00:50:52,280 --> 00:50:53,720 He's good, isn't he? 904 00:50:53,720 --> 00:50:54,880 LAUGHTER 905 00:50:54,880 --> 00:50:56,440 No, I don't think so! 906 00:50:58,160 --> 00:51:01,120 Sometimes we do find that with anorexia there is something 907 00:51:01,120 --> 00:51:05,400 that keeps people stuck in it, where they do elicit lots of care 908 00:51:05,400 --> 00:51:08,360 from others. You know, maybe that's making up for something 909 00:51:08,360 --> 00:51:10,440 that they haven't quite had. 910 00:51:13,240 --> 00:51:16,520 I was struck by Janet's observation about not growing up. 911 00:51:20,280 --> 00:51:21,520 - This is you. - Yeah. 912 00:51:22,840 --> 00:51:26,560 It may be part of the seduction of anorexia that it keeps life 913 00:51:26,560 --> 00:51:27,800 at arm's length. 914 00:51:27,800 --> 00:51:30,160 That was my ex, a musician, Paul. 915 00:51:31,360 --> 00:51:34,760 - He looks groovy. - We got engaged. - What, and it didn't work out? 916 00:51:34,760 --> 00:51:36,400 - No. - Have you been married? - No. 917 00:51:36,400 --> 00:51:38,040 Engaged, twice. 918 00:51:38,040 --> 00:51:39,760 - And what happened? - I broke it off. 919 00:51:39,760 --> 00:51:42,640 - Why? - Eating with them became an issue. 920 00:51:42,640 --> 00:51:43,960 - Is that you? - Yeah. 921 00:51:43,960 --> 00:51:46,240 Eating became an issue in the relationship? 922 00:51:46,240 --> 00:51:47,320 - Yeah. - In what way? 923 00:51:47,320 --> 00:51:49,520 Because they said I wasn't eating enough 924 00:51:49,520 --> 00:51:52,840 and I didn't want to eat more and I had to sit down every evening, 925 00:51:52,840 --> 00:51:55,560 because we lived together, for a meal and I wasn't eating enough 926 00:51:55,560 --> 00:51:57,120 and it used to start arguments 927 00:51:57,120 --> 00:51:59,880 and I felt they were putting too much pressure on me. 928 00:51:59,880 --> 00:52:03,920 I didn't like it. I'd rather not have them and not eat. 929 00:52:05,640 --> 00:52:08,840 For those who feel a lack of control in their lives, 930 00:52:08,840 --> 00:52:13,000 anorexia offers the illusion of ultimate control, 931 00:52:13,000 --> 00:52:16,040 at the price of the years of missed opportunities. 932 00:52:22,960 --> 00:52:26,920 I was back in East London with an appointment to see Rosie, 933 00:52:26,920 --> 00:52:29,840 now living at home, while being treated as an outpatient. 934 00:52:31,280 --> 00:52:34,280 Of the people I'd met, she was the one who had seemed most confident 935 00:52:34,280 --> 00:52:35,640 of recovery. 936 00:52:36,600 --> 00:52:38,840 I wondered if things were still looking up. 937 00:52:43,520 --> 00:52:45,560 - Hello. - Hello! 938 00:52:45,560 --> 00:52:48,000 - How are you doing? - Good, how are you? 939 00:52:48,000 --> 00:52:52,000 Yeah, good. I was going to say, you look great and then I was like, 940 00:52:52,000 --> 00:52:54,520 "Hang on, I don't even know if I'm supposed to say that." 941 00:52:54,520 --> 00:52:58,280 - Different? - You know, what is it therapeutically advisable to say? 942 00:52:58,280 --> 00:53:00,600 You look...how you look. 943 00:53:00,600 --> 00:53:02,440 - That sounds weird. - Yeah. 944 00:53:02,440 --> 00:53:03,680 I think I know what you mean. 945 00:53:03,680 --> 00:53:05,680 - Yes. - Come in. - How are you doing? 946 00:53:05,680 --> 00:53:07,000 Yeah, I'm well. 947 00:53:07,000 --> 00:53:08,880 I'll come in. 948 00:53:08,880 --> 00:53:12,120 - Nice to see you. - Yeah, you, too. - Cheers. 949 00:53:13,280 --> 00:53:15,840 - You've been discharged now. - Yeah, officially. 950 00:53:15,840 --> 00:53:17,760 Obviously, they gave me the two-week trial. 951 00:53:19,000 --> 00:53:23,520 I done the first week and my weight had stayed the same, 952 00:53:23,520 --> 00:53:24,920 but that was a positive. 953 00:53:26,080 --> 00:53:31,120 Then I done another week at home and I had gained 0.7, so... 954 00:53:31,120 --> 00:53:33,440 Wow. That's great, congratulations. 955 00:53:33,440 --> 00:53:35,080 Thank you. 956 00:53:35,080 --> 00:53:38,880 Some of the people I speak to, who have eating disorders, 957 00:53:38,880 --> 00:53:43,440 they're much more in two minds about putting on weight 958 00:53:43,440 --> 00:53:47,240 or looking more healthy. 959 00:53:47,240 --> 00:53:49,200 Yeah. I know I need to do this, 960 00:53:49,200 --> 00:53:51,400 I know I need to put on the weight because otherwise... 961 00:53:51,400 --> 00:53:52,920 I really do not want to go back there. 962 00:53:52,920 --> 00:53:55,640 I do not want to step back in that ward. 963 00:53:55,640 --> 00:53:58,040 And I'm motivated, you know? 964 00:53:58,040 --> 00:54:01,640 I know where I've been before and I know I can do it, but... 965 00:54:02,640 --> 00:54:05,240 It's just, you know, you are always in two minds. 966 00:54:05,240 --> 00:54:08,040 If I've taken away anything from all of this, it's that the healthy 967 00:54:08,040 --> 00:54:10,760 and the unhealthy impulses get intertwined 968 00:54:10,760 --> 00:54:15,160 to such an extent that it's sometimes hard to separate the two. 969 00:54:15,160 --> 00:54:16,920 Yeah. 970 00:54:26,200 --> 00:54:27,720 MICROWAVE BEEPS 971 00:54:30,920 --> 00:54:33,920 Rosie's future was hard to predict. 972 00:54:33,920 --> 00:54:37,120 I could only hope that she would be among that group of patients 973 00:54:37,120 --> 00:54:40,920 who make a full recovery and return to the normal life 974 00:54:40,920 --> 00:54:43,480 she'd known only a year before. 975 00:54:59,200 --> 00:55:01,920 Are you still going to watch me eat? 976 00:55:01,920 --> 00:55:04,800 - Is that going to make you uncomfortable? - Yeah, I'd rather not. 977 00:55:04,800 --> 00:55:06,200 - Really? - Yeah. 978 00:55:07,280 --> 00:55:09,280 - You want me to leave? - Sorry. 979 00:55:25,000 --> 00:55:27,840 She doesn't want us there when she's having her tea. 980 00:55:29,600 --> 00:55:31,680 It's still stressful for her. 981 00:55:31,680 --> 00:55:33,360 Very stressful, indeed. 982 00:55:33,360 --> 00:55:34,920 Very, very stressful. 983 00:55:34,920 --> 00:55:36,640 She's still battling. 984 00:55:36,640 --> 00:55:38,200 Yeah. 985 00:55:38,200 --> 00:55:39,720 In her mind, she is, yeah. 986 00:55:39,720 --> 00:55:41,960 - Would you agree, Heather? - You know, like, she goes, 987 00:55:41,960 --> 00:55:43,440 "I can't do this no more. I can't..." 988 00:55:43,440 --> 00:55:47,120 I say, "Deep breath, count to ten, 989 00:55:47,120 --> 00:55:50,240 "think of something nice and that feeling will go." 990 00:55:50,240 --> 00:55:51,760 And that's what she does. 991 00:55:53,400 --> 00:55:56,720 She gets upset sometimes because she thinks she's failing again. 992 00:55:57,800 --> 00:56:00,360 You think there's a little voice in her still saying, 993 00:56:00,360 --> 00:56:02,880 "Don't put on any more, you've done enough?" 994 00:56:02,880 --> 00:56:06,360 - No, she knows. - That voice is still there, I think. 995 00:56:06,360 --> 00:56:08,440 - I think so. - A little bit. 996 00:56:08,440 --> 00:56:12,000 You don't have it to that extent for all those months 997 00:56:12,000 --> 00:56:14,040 and then have it go like that. 998 00:56:14,040 --> 00:56:16,360 No, that's right. I think it's still... 999 00:56:16,360 --> 00:56:18,000 - Oh, yeah. - It's still there. 1000 00:56:18,000 --> 00:56:19,560 - It's still there. - It's lurking. 1001 00:56:19,560 --> 00:56:21,200 - Yeah. - Yeah. 1002 00:56:21,200 --> 00:56:24,880 But she'll get there. I can see a big, huge difference. 1003 00:56:24,880 --> 00:56:26,640 And you think she's serious. 1004 00:56:26,640 --> 00:56:28,160 - Oh, yeah. - About doing it? 1005 00:56:28,160 --> 00:56:29,880 - Oh, yeah. Definitely. - Definitely now. 1006 00:56:29,880 --> 00:56:33,480 She said to me, "I never, ever want to go back, ever." 1007 00:56:37,320 --> 00:56:38,440 DOOR OPENS 1008 00:56:39,440 --> 00:56:40,800 - Hello. - Hello. 1009 00:56:44,840 --> 00:56:47,360 - I keep forgetting you've had your hair done! - Yeah. 1010 00:56:50,240 --> 00:56:52,120 We were talking about you. 1011 00:56:52,120 --> 00:56:53,720 I thought my ears were burning. 1012 00:56:56,040 --> 00:56:57,520 - Good, I hope. - All good. 1013 00:56:57,520 --> 00:56:59,200 Yeah. 1014 00:56:59,200 --> 00:57:03,560 - Of course. - It's not always good, so I don't know why you're pretending. 1015 00:57:03,560 --> 00:57:06,800 - No, it was. It was all good. - OK. 1016 00:57:19,840 --> 00:57:23,320 Do you think that it's part of the human condition in some way? 1017 00:57:23,320 --> 00:57:26,400 I mean, it's always been with us and will always be with us. 1018 00:57:26,400 --> 00:57:28,640 Yeah, I think both. I think it's always been with us, 1019 00:57:28,640 --> 00:57:32,320 it will always be with us and there are things about our culture 1020 00:57:32,320 --> 00:57:35,600 currently that increase the prevalence. 1021 00:57:37,520 --> 00:57:41,880 So the genetic vulnerability we're born with interacts 1022 00:57:41,880 --> 00:57:45,400 with the experiences that we have as children and growing up 1023 00:57:45,400 --> 00:57:48,880 and those are experiences of family, experience of peer groups 1024 00:57:48,880 --> 00:57:50,920 and the social world that we live in. 1025 00:57:50,920 --> 00:57:54,120 But the interaction between all of these factors, for some, 1026 00:57:54,120 --> 00:57:56,360 will trigger the illness. 1027 00:57:56,360 --> 00:58:00,000 Anorexia is an illness associated with appearances. 1028 00:58:01,000 --> 00:58:04,000 But in my time speaking to people with the disorder, 1029 00:58:04,000 --> 00:58:07,800 I've been struck by how much it had to do with the deepest feelings 1030 00:58:07,800 --> 00:58:10,840 of powerlessness and lack of self-worth. 1031 00:58:17,320 --> 00:58:20,240 It intertwines itself with positive qualities, 1032 00:58:20,240 --> 00:58:23,560 like conscientiousness and self-discipline 1033 00:58:23,560 --> 00:58:25,480 and makes them poisonous. 1034 00:58:25,480 --> 00:58:29,840 Demanding from those who have it, a daily heroism in facing down 1035 00:58:29,840 --> 00:58:33,800 an illness often indistinguishable from their own selves.