EATING disorders specialist Suzanne Horgan has never forgotten her 14-year-old client who, dehydrated from an eating disorder, was in hospital getting re-hydrated. The doctor said: ‘Do you realise you’re taking up a bed on someone who’s really sick?’
His comment, says Horgan, reflects a pervasive attitude that eating disorder is a lifestyle choice — the person’s choosing to restrict, to purge, to look a certain way. “People think it’s about vanity, about looking for attention. They have this attitude ‘you’re doing it to yourself’.”
Instead, she says, there’s a growling voice in the sufferer’s head, telling them to practise particular behaviours or else something bad will happen. “This is an illness, a psychiatric disorder. It’s about deeper issues, about needing to be in control, needing to be perfect. It’s about an inability to handle and express feelings.”
Trish Shiel, clinical manager at Eating Disorder Centre Cork (EDCC), calls eating disorders the ‘Cinderella of mental health’. EDCC has 60-70 eating disorder sufferers on its books, mostly aged between 20 and 35, mostly women.
“With suicide ideation, people say ‘oh, your head’s in a very bad place’. With eating disorder, they don’t — they say ‘why don’t you just eat, why are you making such a drama out of this?’” says Shiel, who observes people opening up about depression, anxiety, suicide ideation, trauma linked to sex abuse — but not about eating disorders. “And yet people die from eating disorder more than from any other mental health condition.”
With Eating Disorder Awareness Week running until March 1, EDCC worked with third year Visual Media Communication students from CIT on a poster project, aiming to highlight the theme ‘Reducing Stigma and Shame Associated with Eating Disorders’. The posters are on exhibition throughout this week at The Gallery, 46 Grand Parade.
Shame and stigma stalk the eating disorder world. Shiel sees it at the onset of illness, when weight-shaming poses a huge threat to psychological and physical health. “People make comments about someone’s body — the size of their legs, their height or weight — without permission. And there’s a lack of representation of size diversity on programmes like Love Island. Many young women watch this and subliminally take in the message that you need to look like this in order to find love. It’s very serious — young people feel inadequate after watching it.”
She sees huge guilt, with eating disorder sufferers feeling it’s all their fault and parents racking their brains, wondering ‘what might I have done to cause this — maybe my child was anxious when they were little and I didn’t catch it, maybe I dieted too much’. These kinds of thoughts, says Shiel, are because people misinterpret what eating disorder is. “It’s not about food. People get waylaid by that.”
Adding that sufferers literally want to “crawl out of their skin”, Shiel recalls one young woman saying ‘all my life I was trying to be invisible when in fact I was invisible — people just didn’t see me’.
“She wanted to disappear. She didn’t feel she deserved to live. Eating disorder grinds a person down. Her pain was invisible to her family. The purpose of an eating disorder is to numb out pain but the thoughts in your head are 100% abuse from the eating disorder. It’s a cruel, barren, isolating landscape and what the person needs is to thaw out, to get in touch with and regulate their emotions and to manage their anxieties and thoughts.”
Horgan says Joe Duffy’s recent interviews on Liveline highlighted insufficient numbers of healthcare professionals trained to treat eating disorder and the lack of funding, support, education and facilities to address this debilitating illness. “Eighty-five percent of people report it’s hard to access appropriate treatment due to lack of trained healthcare professionals.”
And with 200,000 people in Ireland estimated to be experiencing some form of eating disorder, she sees a huge stigma blocking men from coming forward. “Men don’t see it as a male issue — they’re brainwashed into thinking it’s a female-only one.”
Horgan also points out that eating disorder impacts the entire family, not just the sufferer. “The family can get forgotten in the process. They need as much support as the sufferer, especially in after-care when the sufferer’s living at home or very young.”
With early intervention crucial, she cites warning signs: preoccupation with food/body/weight, skipping meals, food going missing/hiding food, obsession with stick-thin magazine images, disappearing into bathroom for long periods and excessive weight loss in short period of time. If concerned, the best approach isn’t to back the person into a corner. Instead, use non-threatening ‘I’ messages: ‘I’m just a bit concerned.’ ‘I’d like to understand.’ ‘Is there anything I can help with?’
“In many cases, sufferers deny there’s a problem. The eating disorder’s their way of coping and they resist this coping mechanism being taken from them,” says Horgan.
Her approach in therapy is to say ‘I’m not going to take this from you. I’m going to help you to want to let it go. I’m going to help you to find other coping mechanisms by developing other skills’. These, she says, might be communication and problem-solving skills, assertiveness and stress management. “Once you address the needs being met by the behaviour, the behaviour becomes obsolete.”
For Cork-based Cora Grant, now in her early 40s, eating disorder manifested in her early teens. “Restricting food was my go-to. My internal voice was full of savagery and hopelessness, affecting every thought I had. It told me I had no future, nothing would work out. It was like a sat nav for destruction targeted against myself.”
The illness compromised Cora’s physical and mental health, her career was “in tatters with lots of periods of unemployment”. It impacted her finances and she couldn’t maintain connections with others or with hobbies. “How can you if your basic mindset is targeted against you?”
The turning point came in her mid to late 30s, when she accepted she had an eating disorder. “I’d reached the point where I had to accept the truth — it was the only way to get out of it. I knew of three people who’d died from eating disorder — that was sobering. I really became aware this is a killer – and I wanted to stick around, so I committed to taking it on and getting better.”
The other vital piece was getting specialist help. “I wasn’t a label to them and they reiterated at all times that full recovery was possible. So I clawed back my life, rebuilding every part of it. I educated myself about what I was dealing with — how eating disorder isn’t a choice or phase, but an embedded thing that comes for very complex reasons.”
Today, Cora is where she once thought never possible. “I’m really well. I’m physically healthy. I have peace and clarity of mind now. I work full-time. I’ve got great connections and friends. I have a vision of myself and what I can contribute.”
All of which proves the truth of what Trish Shiel firmly believes: “You don’t have to be dogged by the eating disorder voice all your life.”