Small Acts of Disappearance (8 page)

I know that at first, at least, I was braver when I was with these women, that when we ate together in hospital it seemed
easier, sometimes, because we all knew that we all found it difficult and horribly strange. I still watch undiseased eaters having dinner and wonder at their thoughtlessness, their ease. Another of these women has a vegetarian boyfriend who eats a steak whenever she tries something challenging and new.

My doctors never tire of telling me that we're the unlucky ones. That in almost every other mental illness, treating the symptoms makes the patient feel better, even if only in increments. That depression lifts a little, the anxious find moments of calm. But for us, when we start to eat again, doing something that distresses us six times a day, each and every day, something that our every instinct still screams against, all of the smaller hungers that our one great physical hunger has damped down, for all those years, rear up. We feel worse, far worse, when we don't have our hunger to protect us. I never thought that I would feel as much – sweeping sadness, flashes of embarrassment that make me nauseous, unbridled fury, even something I didn't recognise, at first, as loneliness – and to feel as often as I do now that I'm without my hunger. Hunger suppresses the emotions – and this is often part of its appeal – because it is impossible to get riled up about anything when your body is diverting all the energy it can muster on simply trying to stay alive.

Shortly after my first hospital admission, I started reading medical books and cultural histories of hunger. I was trying to understand this deeper, more complicated side of my
illness that I'd been unable, for so long, to recognise within myself, to know its face and shape as if that alone could pull me clear. I learned that when ‘hysterical anorexia', as the condition was originally named, was first described medically, it was considered a perversion of the will, and treatment was commensurately harsh. Patients were forcibly removed from their families – in what was known, rather wonderfully, as a ‘parentectomy' – usually to a convent or farm. Force-feeding was both common and primitive, often resulting in broken teeth and torn oesophaguses; and many patients were bound to their beds. Even in the early twentieth century, anorexia was considered a neurotic denial of adulthood and sexuality, and treatment involved taking frequent vaginal swabs to assess the ‘vitality' of its fluids, alongside injections of stimulating sex hormones, at a time when the patients' higher cognitive functions were compromised by malnutrition, and they were surrounded almost exclusively by male physicians and psychiatrists. In the fifties and sixties, patients were kept heavily sedated, often for years. In Australia, at the moment, no state has more than about eight public hospital beds for adult eating disorder patients; these beds are all in locked psychiatric wards, the waiting lists are often up to thirty-six weeks long and only available to the critically underweight and medically imperiled. I had to fight, and fight hard, to get the treatment that I needed, and I had to learn as I went, by trial and sometimes damaging error, precisely what that treatment might be. My physical condition complicates the usual treatments for anorexia: often, when I've tried to eat a
food that I'm afraid of as an exercise in exposure, I've been unable to keep it down and become even more fearful as a result. I physically struggle, too, with the full-sized meals that are a part of any prescribed meal plan. And yet I know I'm not unlucky, in comparison with what has gone before.

Modern medicine still doesn't understand the pathology of anorexia, what causes any one person to turn their hunger inward while another remains untouched. Genetics plays a role, and personality; power plays a role, and so do sexuality and family and a whole range of emotions and emotional responses. So too can trauma, and striving, belonging, acceptance, acceptability and self-esteem. All of these smaller, unbearable hungers that are starved away or diminished, when the body is kept unfed.

But however similar we become as we shrink away from ourselves and from the world, the specificity of these diseases confounds me still. In the hospital, I met a springy-haired woman who was studying medicine and found that she focussed better on the slightly manic energy that comes with mild starvation. Another, dimpled and defiant, had grown up in foster care, and learnt that if she stopped eating in a house she didn't like, she would have to be moved elsewhere. Her best friend from university, who had started with a celebrity diet and liked the results a bit too much: this woman was terrified by the idea of eating a banana, but would happily have a chocolate bar, whereas another thought dairy
foods were all unnecessary and unnatural. Some of us were horrified by carbohydrates, others by sugar, others by adding oil to a pan – often depending on which nutritional craze had been most prominent when we each first became ill. Other fears were harder to determine in their origin, but equally irrational: red meat but not chicken, muffins but not cakes, rice except in sushi. One woman, who'd told her workplace she was in Fiji and not in hospital, considered pineapples too high in energy to eat. I've been terrified, by turns, of apples, eggplant, tofu, melted cheese. There's a specificity to these symptoms, to these fears, against which all of the theorising and rationalising, all of the thinking and writing that I do falls down entirely.

Yet in the early weeks of my first hospital admission – which took place almost three years after that evening of sobbing over my steering wheel – I realised that the first thing that we were being given was a language. In some ways it is a jargon, that kind of language that speaks only to the initiated, that carries with it its own definition of inclusion: there are terms and phrases like ‘safe food,' ‘self-compassion', ‘replacing'; even ‘recovery' that only a patient, former or otherwise, will use. We learnt to speak about ‘symptoms' and ‘behaviours', rather than about the things we'd done and the mistakes we'd made. About ‘urges' and ‘distress' as if they were distanced and defined things, specific and somehow separable from our interior lives. We were told to
speak about ‘energy density'; about ‘normal' rather than full-cream milk, ‘fun food' rather than junk. I was expected to learn not to undercut the things I said by making jokes at the end.

We learnt a language, that is, that had our selves removed from it, a language for all of the things we'd spent years keeping unspoken and hidden away. It gave us a direct way of addressing our disease, and a distanced stance away from it; a way to stand outside of it, and stare at it, and make it other. A language to cut ourselves clear. But I still don't know how to write about what it means to get better. Even with a language, provisional as it is, I'm not sure that there can ever be a form that might contain so slippery and fragmentary a process.

My first admission, in a day program, was not physically easy. I struggled terribly – as did the doctors – with the physical symptoms of my disease: I threw up most of the prescribed meals directly onto the table (the bathrooms were, of course, locked). The woman who sat opposite me at meal times took to leaping backwards in her seat whenever I moved suddenly. I skipped breakfasts at home because I knew how much I'd have to eat at the hospital throughout the day. I was so unused to eating snacks that I thought two strawberries would be sufficient to count as morning tea. I had horrible headaches, my stomach distended, my breasts and legs ached, and I've never felt so tired in my life. I lost weight, even though the
whole program was geared towards what we were told to call ‘weight restoration' rather than ‘weight gain'.

In the first weeks, I tried to chat at the meal table, telling stories with accompanying wild hand gestures because the silence was unsettling and painfully artificial. I introduced myself over-brightly on the first morning, even though no one there was able to respond in kind. I was bewildered; and I kept trying to normalise the very strange circumstances we'd found ourselves in, to thicken my skin where it threatened to break. I lost weight again – two hundred grams, I later found out – and was forced to leave the program for a week.

I was terrified. I was being questioned by the doctors about the way I spoke, the way I laughed, the clothes I wore, rather than the only thing that I'd seen as being problematic, the way I ate. The stories that I'd told myself about who I was, what my condition meant, how I really thought and felt, were being pulled apart or dismissed outright; I wanted so much to get better but was so terribly afraid, still unable to let go of the foundation that my hunger gave me. I lost my own belief in the face I'd always shown the world; I still think, sometimes, that I haven't yet got it back.

In the week that I was forced out of the program, I ate cake every day, determined to gain weight by any means. A chocolate lemon meringue that my mother had made from her new cookbook, a pear and Callebaut chocolate tart from Black Star Pastry, a brandied prune and vanilla torte from
Bourke St Bakery, a brownie from the café near my house in which I did most of my writing. A baked ricotta cheesecake from Papa's Patisserie in Haberfield, the sticky date pudding I'm famous for amongst my friends. I would stop and ask to take the rest away as soon as I felt my stomach muscles flensing. I cried a lot. ‘You're living my dream,' the dietician said. I smiled, though I wanted to slap her, and hard.

I was put on supplements, small bottles of almost viscous milk with a chalky aftertaste barely disguised by their purported flavours. Each bottle contained the equivalent energy of a small meal, and I was able to keep them down; I was drinking, most days, four of these each day, on top of the regimented three meals, three snacks, three hours apart, that I'm still following, even now. And my body did recover, but I left the hospital, that first time, feeling like my mind had been left far behind.

On the day I was discharged, I spent the morning group session sobbing on the couch, because I so desperately wanted to stay, I was so uncertain of myself and my ability to hold steady on my own. I gathered, that night, a group of friends at a Newtown bar, knowing they'd all insist on buying me celebration drinks. I wore a new dress that I'd bought because its plunging neckline showed off the area where most of my new weight had settled. Nobody wanted to order dinner, because the place I'd chosen wasn't cheap, and I didn't want to do it on my own, so I sat there, and chewed on the limes in my drink, and I swore, over and over, that I'd never go back to hospital again.

I started in a new job. A new housemate moved in. I bought new clothes, and realised that the things I instinctively picked off the shelves – full skirts, shift dresses, pleated embellishments – were things that had suited my underweight frame, but looked strange and lumpish on me now. I went to yoga classes, and couldn't bend and reach in the way I was used to. I kept trying to eat new things but I kept making small concessions too, and within months, I was living off steamed vegetables again. But this time I knew the face of my disease, this time I knew that what I was doing was madness, was destruction, was obscene, this time I was pushing, and pushing hard, towards annihilation. I never thought that I would feel so much and so often without my hunger, and I didn't know how else to cope.

By the time I went back to the hospital for a second admission, almost all of the other women who had been contained there with me had already been back, and one had been admitted as an in-patient to an expensive private clinic, often the only option for people whom the underfunded public system can't accept or accommodate. I'd completed an online follow-up survey of psychometric measures and been startled by my poor results, then gone straight to a bar with some friends, sucking back cocktails and swearing that I'd never go back, that I couldn't. But by the time I went back to the hospital I had spent six weeks trying to prove myself to the program directors, keeping meticulous food
and exercise diaries, having blood tests and being weighed weekly. I'd stopped working and I'd spent another birthday unable to eat a slice of my own cake.

I thought I'd be unshockable in my second admission, because I knew what was going to be demanded of me and I knew I wouldn't like it, but at least I'd be prepared. I felt a deep sadness every time I finished a meal, rather than a blinding panic when I sat down at the table. I swallowed my own vomit under threat of being forced to leave the program and sat for hours with the taste in the back of my throat. I learnt that if I spoke harshly, self-punitively about my slip-ups and ‘behaviours', the psychologists wouldn't reprimand me and I could all but get away with skipping meals, or parts of meals, or choosing only options that didn't cause me fear. I ran baths every evening and watched my body breathing, softening under the warm water, and I cried in great shuddering sighs while my housemates watched TV in the next room.

In my second admission to the hospital, we went on an outing to a chocolate café that I'd visited several times, over the years, with the same group of friends, stirring saccharine into my coffee while they'd eaten doughnuts dipped in chocolate sauce or brownies that slowly puddled up their ice-cream. I stared down at my cake and couldn't stop thinking about everything that may always have been possible, when I'd been so deeply convinced otherwise, everything I'd been too scared to do. Everything I'd lost over the decade of my disease.

I've been admitted elsewhere since then, worked individually with psychologists and dietitians of my own, sometimes having appointments on four days in the week, still with no end in sight. I never can know how long I'll need this kind of support, which things will shift or stick or change, and when; only that the important changes are always things I do not recognise when they occur.

More and more I can't believe that I thought I ever would be able to understand exactly what it was that I had been through, ever be able to find a way to pin the experience down when what I think about it changes every time I hold it up to scrutiny. Because the brain physically changes, too, with hunger; like the body, it narrows and sharpens and grows harder, shuts down all the areas that aren't essential for survival. So too as the body recovers does it reshape itself: the brain is physically repatterned as we change the ways we act and eat.