An Apple a Day (2 page)

But that was then, that was over ten years ago . . . Somehow I stayed out of the hospital and got through my Oxford finals and got myself out of the danger zone. I've had a good career in publishing and journalism ever since. I bought my own flat in a trendy part of North London with not-too-noisy neighbors. I have a crazy but loving family—two brothers, two sisters, two parents, and an ever-expanding troop of nephews and nieces. Two years ago I met Tom, my boyfriend (of whom I'll say much more later).

But here's the thing: I never actually got better. I put on some weight—enough that I don't get stared at in the street these days, enough that lying in bed isn't painful anymore—but I never found a cure for the illness in my head. Anorexia is such a visible condition, and people focus relentlessly on the body shape and weight of the sufferer. This leads to the common misconception that anorexia is about looking good—that sufferers are losing weight in order to attain the perfect body.

What bullshit. There's nothing less attractive than wasting away; no anorexic thinks they actually look sexy. You avoid interaction with others, and you fear human contact. You don't have the slightest desire for sex, or even for flirting, and you certainly don't want to flaunt your scrawny body. When you're staying alive on almost zero food you have no energy left over for the outside world, for fun or sex. I won't pretend that I didn't have sexual relationships when I was at my thinnest—I did, and anorexics do—but the feel-good hormones aren't really there. It's hard enough just thinking straight when you have so little fuel.

To me, the focus on body shape is misguided. For such a physical illness, anorexia has surprisingly little to do with external appearance. Of course it usually starts out that way, as a normal diet, but it quickly transmutes into an internal sickness. My experience of anorexia is of a profound disconnect between my body and my mind. The more weight I lost, the more I retreated into myself; I became a human husk, cold and isolated. I felt so brittle I avoided hugs.

My rock bottom: dropping below 85 pounds. Everything began to shut down. Oxford is “on the clay,” which means it gets extremely cold in winter. The only thing that still functioned was my brain, just about, so I concentrated on my university degree. I spent hours in the Upper Reading Room of the Bodleian Library memorizing vast chunks of the Old English set texts. When the outside world got to be too much, I locked myself in my college room writing essays on the metaphysical poets. I knew I had to focus on reading and writing and passing my finals before I lost my mental faculties too.

Friends at university were worried and they talked, first to my face and then behind my back. Call it defensiveness or pride, but I've always detested pity. I hate the feeling that people are “concerned” about me: I'd rather be bitched about than pitied. But what do you say to someone who is fading away? Yes, I went
to see doctors. I only had to step on the scale for them to make the diagnosis. As a teenager, I'd always been an average height and weight—at five foot six I weighed between 125 and 135 pounds. So, by dropping to 85 pounds and then lower, I more than fulfilled the strict medical criterion for anorexia: the loss of a third of your body weight.

In the end I just wanted everyone to leave me alone.

Anorexia is a frightening word. Of course I'd known I was sick long before any health professional used the term—I felt myself spiraling downward, my body in free fall. What had started as a diet got way out of control. Quite quickly I found I was struggling to eat anything at all. I would cut out certain food groups (all fats), then cut out specific foods, and then find ways to cut out more. (There never was a plateau, weirdly: even at the lowest food intake it always seemed possible to reduce it further.) Every time I put on my Levi's they were looser. I was losing weight at a rate of knots. I knew I was in serious trouble, sure. But it's a shock, nonetheless; something like the first time you hear the word “cancer,” or even “alcoholic.”

On a personal level, let me tell you what the repeated use of that label does. It makes you sicker; it traps you in the condition. They have defined you as an anorexic, so you must be thin, right? From that point on, whenever you eat (even if it's just raw carrots) you feel like a fraud. If you were a proper anorexic, you wouldn't eat, that's what the voice inside your head tells you.

And even when you're getting better, the label is misleading: when you put on weight, you will be cured, right? The key to beating anorexia is to gain weight, isn't it? Wrong, wrong, wrong. The illness is in my head, not on the scale or in the size of my body.

Throughout this book, whenever I refer to weight—whether I've gained or lost—how much we're all supposed to weigh, a normal or abnormal body mass index (BMI), please remember
this: anorexia is a mental illness. Gaining weight is the physical cure, of course, but it doesn't deal with the sickness.

Don't believe me? I know a woman who is 266 pounds who still has anorexia. She has gained the weight back (and more), and this means that on strict medical criterion she is no longer defined as anorexic. But that's precisely the point. Mentally, she has never recovered from the disease.

* * *

More than ten years on from those skeletal Oxford days, I now have the confidence to say that I haven't recovered either. I've remained underweight, hovering in the twilight zone. I look normal, but I haven't had my period for over a decade. (Writing that shocks me.)

The problem with this kind of “functional” anorexia is that you can carry on forever—there's no talk of emergency measures, no hospitalization or force-feeding. You seem OK, just thin. The recent vogue for “managed anorexia” is alarming: managed anorexics are normal women, with careers, children, normal lives, who admit to being constantly, obsessively vigilant about what they eat in order to remain thin. The discussion of managed anorexia is often humorous in tone, flippant even, but there's nothing funny about semi-starvation. I believe that a lot of women are living like this, hungry all the time.

And at this level, just hovering in the underweight category on the BMI charts, the health risks are mostly invisible—amenorrhoea (loss of periods), infertility, depression, insomnia, and osteopenia (the precursor to osteoporosis, severe loss of bone density). You can't see these things from the outside. No big deal, no crisis.

But of course it's a crisis, I know that. Every day that goes by now is another day wasted.

In the end it's about change, the paralyzing fear of change. Anorexia keeps you frozen in its icy grip. The notion that life could be any different—that it could be better—becomes inconceivable. You forget how good it was to be normal. Worst of all, you come to believe you prefer it this way. I've been trapped for too long. It's time to stop the madness.

* * *

So why now? It began in the autumn, after a conversation with my boyfriend, Tom, when he said, “There's one more thing I want you to promise me.” He looked more serious than I'd ever seen him. “You have to stop running. And if we're serious about having a baby, you have to eat more.” Stop running
and
start eating, was he kidding? What did he think I was, Wonder Woman? Running is my lifesaver, my natural Prozac; it's the addiction that replaced cigarettes five years ago.

We were sitting in Starbucks in St. Katharine Docks (the best Starbucks in London with its Palladian dome and secret top floor). The place was packed with secretaries and business men in suits, holding work meetings or catching up on gossip. We were tucked away at our favorite table in the corner. Stop running? I eyed my boyfriend skeptically over the rim of my grande decaf black Americano.

“I mean it, Em, you're going to have to cut out the running. You've been avoiding this for way too long.” He looked at me and I looked back and neither of us said a word. This was an ultimatum of sorts, we both knew that.

And Tom wasn't telling me anything new: I've known for years that my lifestyle is unsustainable. Getting up at 6
AM
and running four or five miles on nothing but a double espresso, burning up fuel (and fat and muscle) that I simply don't have to spare. I was
out there pounding the pavement every morning without fail, rain or shine; I was running myself into the ground. I could carry on that way forever, but there'd be no chance of having a baby. Yes, I understood that.

Tom reached across and took my hand, softening the tension in the air. “I know you can do this, Em, your body needs a break. And as well as cutting out the running, you're going to have to start eating properly. Eating isn't greedy—it's fuel; it's about our plans and dreams, making all that possible. It's you taking the decision to get your health back, simple as that.”

We'd had this conversation many times before—sometimes in anger, sometimes in sadness or despair—but that time it was different. That day we talked about the future with a new seriousness, all the happy things that could be waiting around the corner (a baby among them) if only I could get myself unstuck. It's a question of gaining 10 or 20 pounds, according to my doctors. So little and yet so much.

In addition to control and food and body image and all the other issues in eating disorders, there's a huge degree of self-deceit. It's not rocket science and I know it: I haven't recovered because I haven't wanted it
enough
.

And here's the thing: time runs out. Remember your twenties? Didn't you feel like you were invincible? I had serious boyfriends, but I didn't seriously want to have children back then. I was too busy building my career, and buying my first flat, and generally finding out who I was . . . it was never the right time or place for children.

But sitting in Starbucks that autumn day, I felt differently. Looking across at Tom, thinking about our future, our baby, making a home, a family together, I realized now I wanted all that more than I wanted to be thin. When I think of the wasted years, the evenings spent alone, the friends lost, the conviviality and enjoyment of eating with others, all those shared meals I've
avoided . . . it strikes me as incredibly sad. I'll never get those years back. Anorexia is a young person's game and I don't have the time or energy to play anymore.

I knew Tom was right; I knew something had to change. People have told me I have an iron will, resisting food, starving myself into oblivion and all that . . . but I didn't know if I had the willpower for this.

That was the hardest and most honest conversation Tom and I had ever had. I agreed to stop running and start eating. We finished our coffees and walked along the docks and kissed goodbye; Tom went back to his office and I went off to find my bike.

Cycling back through the city, around the Barbican and up to Angel, I was filled with hope and fear. The wind in my hair, the first chill of autumn in the air, the promise of a new start. I stopped at Sainsbury's and bought a large pot of natural organic probiotic yogurt
with fat
. Not much fat (and admittedly I dithered in front of the freezer for half an hour) but it was a huge step for a fat-phobic food dodger like me.

Eyeing my running shoes later that evening, I realized this was going to be bloody hard to put into practice. Waking up and not running? Waking up and eating instead? How do other people do it?

* * *

It's been eleven weeks since that conversation with Tom in Starbucks—exactly eleven weeks since my last run. Of course I'm still procrastinating: sitting here typing about recovery, all words and no action. Yes, I've stopped running. That was the promise I made and I miss it every morning. I'm convinced I've lost muscle tone, but I keep telling myself it's a small price to pay to get my life back. Not running is the strongest thing I've done in ages. But what about eating?

Well, I'm having limited success. Eating is something I find unaccountably, inexplicably complicated. It feels greedy. I worry that if I start, I'll never be able to stop. And anyway, I don't think I deserve to eat.

Recovery from anorexia is hard, because it involves a whole new way of thinking. Tom compares it to giving up smoking or cutting back on booze, but that's not quite right. I gave up smoking, I can go weeks without drinking, but
starting
to eat is a different challenge altogether. Getting through the withdrawal of nicotine was tough, no doubt about it, but it was all about willpower. And there were immediate benefits to kicking the habit: I found I could run faster, for longer; I could breathe more easily; my skin looked clearer, fresher. With eating, for a recovering anorexic, there seem to be no rewards: all that will happen, for a certainty, is that you will gain weight. And that's the thing you dread above all else.

Nevertheless, I made the commitment: I will start eating.

* * *

First, I want to set out what politicians call their
red lines
. As with the rest of my life there will be rules. There are things I will try to do differently and other things I can't change. Most obviously, being a vegetarian . . . I'm not going to start eating meat or fish or anything living. I won't willingly add fat to food—I don't want butter on my bread—and I won't eat rich, creamy sauces. I will accept some essential fats—balsamic vinegar and olive oil on salads for example—although I can't see myself eating handfuls of nuts. I will drink semi-skimmed milk, not skimmed. I will not feel guilty for eating bread and pasta or other carbohydrates. I will eat in public, if I have to; I will try to eat unscheduled food once in a while (an impromptu biscuit offered around the office, a slice of birthday cake). I will eat because my body says it's hungry,
because it needs energy to function. I will finally throw away my size zero clothes—I have been putting this off for months now—I'll go through my wardrobe and get rid of anything that might feel tight as I gain weight. (This, by the way, sounds trivial but is incredibly important to recovery.)