The team at the child and adolescent mental health service took pity on us and decided to pass us on to the specialist eating disorder team for our region faster than usual. We were very grateful.
Ironically, I met the psychologist who helped us in the street a few days ago. This is a small city. I was glad to be able to thank her in person.
The eating disorder team has its own base in a fairly nondescript building in a fairly rough part of town, but it’s run by a world authority on the subject, the professor of child and adolescent psychiatry at a high-ranking university. That’s his academic work. He practises in the place where we live, about 50 kilometres away.
His team consists of at least one other psychiatrist, psychologists, a paediatrician and a dietician. Only he sat with us, but first he introduced the others who were behind a screen.
He went through some basic questions to build up a picture of where we are and how we function and quickly reached the decision that our daughter has anorexia nervosa. The team in the local hospital were pretty sure, but had carried out a series of tests to eliminate every other possible cause of quick weight loss, including Coeliac’s disease, irritable bowel syndrome, diabetes and so on.
With that confirmed, he said very seriously to our daughter: “This is a potentially life-threatening condition and we have to take steps to stop you from becoming very seriously ill.” Coming from him, it really seemed to register with her, I think for the first time.
We all learned lots from listening to this eminent man talk about anorexia. He told us it is a condition that is full of contradictions. Food is what will make you better, but food is what the sufferer fears. The child knows her parents love her and only want her to get better again, but as soon as a parent places a plate of food in front of her, she rails against it like it was poison. I’m sure everyone affected could list a thousand examples.
The professor also said that there are three strands that require attention in treating the anorexia. There is the psychiatric, emotional, psychological side. His team will work on that in their therapy programme. We as parents have to focus on what he called “behaviours around eating”. So, yes, it’s food, but it’s the buying of food, the preparation, the cooking, the sitting down together, the eating and the clearing up afterwards. The third strand, the physiological side of things, is a consequence of these other two. They will weigh and measure her and we are to maintain regular contact with our family doctor and return to the hospital in the event, God forbid, of any further emergency, but we are not to focus on temperature, weight and so on every day.
Behaviours around food, then. Well, the man satisfied himself that we are capable of feeding children. He asked us if either of our other two daughters was underweight. Fortunately they are not. That means we are feeding them properly. That means we can also feed our eldest daughter properly, as we have been doing for almost 13 years. “Do whatever you have to do to keep her eating a normal, healthy diet,” he said.
Gone are the half portions. Gone are the special exemptions from olive oil on salad and butter on potatoes. She eats what her sisters eat. We have to take the flak she throws at us and sit with her until she gets through the food. That’s our job here. Feed the child.
The psychiatrist measured her body mass index and said she was below the first centile; she was at 0.2. He explained this well. He said to her that if she was in a room with 1000 girls her age, only she and one other out of the 1000 would be as thin as she is. Then he said that he knew young women growing up do not like to look round a room and think every girl there is thinner than she is, therefore he is not going to ask her to get back to, say, 50, which is bang on the average. He is aiming for 25. So there would still be 750 girls in the room of 1000 that she would be thinner than.
In practical terms, this means she has to regain 11 kilos in around 22 weeks. Our next appointment is next Tuesday. We are hoping for extra practical advice in how we can manage behaviours around food to make sure we get on the road towards that target. The dietician will be more involved.
The professor was very human. He told our child: “You’re life has just got a little bit off-track. We are going to help you get it back on-track.” His voice was exceedingly gentle and kind when he said this. He also told my wife and me that he is also concerned about us, and about our other children. I was very grateful when he said that.
We are just pleased to be in the programme, to be starting out in the right direction under the guidance of the best in the business, available to us as part of our public health service. Thank God for the visionaries who set programmes like this up. I will never again begrudge a single cent I have to pay in income tax.
We are at the bottom of the mountain. We know as little about anorexia as we will ever know. We are as bad at managing the behaviours around food as we will ever be. Our child is as weak and under-nourished as she will ever. The only way is up.
Peace to all.