Questions were on everyone’s mind: How had this condition arisen? What did this woman in her early middle years have in common with the teenagers who more commonly succumb to this illness? Indeed, the prognosis was bad, for there is even less chance of recovery for sufferers in their later years, than there is for younger ones. A clue to causation lies in Moltmann’s comment about the way in which a person’s self-worth may plummet during serious illness. Chris had been the linchpin of the family, holding together every facet of the whole enterprise, including business, home, and leisure interests. In the long aftermath of that initial virus attack, Chris had been obliged to ‘carry on’ whilst constantly feeling ill, and quite naturally her performance—her ability to get things done—had suffered as a consequence. Despite begging her to let something go, such as giving up her work with the Sea Cadets, she insisted on trying to maintain her life in all its aspects to the fullest extent, and failure to do so for a perfectionist such as Chris, can have only one outcome. Unable to function properly, Chris convinced herself that she simply wasn’t ‘up to the job,’ and in common with other anorexics she lost all sense of her own self-worth. Low self-worth is the common factor shared by all anorexics, both young and old, and the anorexic response to that (wrong-headed) realisation and false self-understanding is also a common one. Anorexics respond by controlling the only thing that they feel is still within their control—their bodies. In the case of young girls, restriction of food intake results ultimately in an arrest of menstruation, with the result that control is imposed upon the biological changes normally brought about during puberty. Effectively, control is imposed upon the (unwanted) arrival of womanhood with all its attendant life changes. In like manner, Chris imposed control upon her own body, as a substitute for the control she now felt she had lost, or was losing over her life. With our return to France had come the full, awful realisation that Chris was now living out an anorexic lifestyle, a lifestyle which had up to that point remained largely concealed.
3
Christian Conversion
We returned home from holiday to a world that was fast changing, and as the decade gave way to a new one, talk of slowing growth and recession, was in the air. At the very time when it became noticeably harder to make sales of the financial products so essential to profitability, Chris’s contribution to the business had diminished to almost zero. Two almost opposing factors were now combining to keep Chris out of the office. Firstly, there was the leaden fatigue and myalgia which is such a defining feature of CFS, and which tied her to her bed until late each morning. Secondly, there was the hyperactivity which can come to dominate the life of an anorexic approaching the latter stages of semi-starvation, and that for Chris, was manifested as three and sometimes five mile walks into the office. Physiological starvation produces significant changes in the brain, reducing neurotransmitter levels in particular, and some animal studies have indicated that hyperactivity could help to reverse this effect. Put simply, hyperactivity could be viewed as a defensive, almost involuntary mechanism, helping to minimize the effects of starvation. In any event, the combined effect of the CFS and the anorexia was that Chris would often turn up at the office towards the middle of the afternoon, invariably leaving again quite soon afterwards because her concentration span was so limited. These two opposing physical effects were, however, to pale into insignificance when compared to another outcome of both illnesses.
As noted already, many sufferers from Chronic Fatigue Syndrome meet the diagnostic criteria for major depression. Likewise, anorexics as a result of the changes to brain chemistry they undergo, invariably suffer from depression in the later stages of semi-starvation. Depression, although not proven to be a direct cause or product of eating disorders, is invariably found associated with them, so much so, that the eating disorders have latterly been described as the ‘new depression’ of the late twentieth century. The vagueness with which depression is linked to the eating disorders is matched by a similarly inexact link with brain chemistry, and with serotonin in particular. Serotonin is a chemical messenger (neurotransmitter) in the brain that is linked with mood and consciousness as well as with eating, sleeping, and sex. Depression is linked with a deficiency of serotonin and may also be linked to obsessive illnesses such as binge eating. As a sufferer from both CFS and anorexia nervosa Chris would have a high probability of also suffering from major depression, but this only became apparent later on through perfect hindsight.
I still had implicit faith in the medical profession at this time, and with Chris maintaining that all her problems stemmed from her enhanced senses of smell and taste, I arranged for her to be admitted to a private hospital at my own expense. Shortly before admission Chris’s depression had become critical and she had begun to express suicidal intent. When this continued during her stay in hospital, a decision was taken to detain her under section 3 of the Mental Health Act 1983 in order to protect her from self-harm. The effect of section 3 is to make a period of detention of up to six months available to the medical staff, during which they can both assess and treat the patient. Paying for a few weeks private care while tests were carried out was one thing, but the prospect of funding a stay of up to six months was quite out of the question. I was immediately obliged to make arrangements for Chris to be transferred to our local NHS hospital, and within two weeks of her admission to the local psychiatric hospital, she had been detained under section 3.
Fortunately, the NHS still had dedicated psychiatric hospitals in most towns at that time, usually set in spacious and beautiful grounds, but tending to group together patients with widely differing complaints. At least Chris was able to enjoy the therapeutic effect of the late summer weather in those gardens, before they came to be sold off to a housing developer and replaced by a so-called ‘secondary unit’ in the nearby general hospital. In addition to her ‘escapes’ into the grounds, Chris actually did escape from the premises on one or two occasions, for she so hated the enforced confinement and pressured food regimes. Inevitably she was returned to hospital by the police, and began to ‘plot’ a more permanent exit by ‘cooperating’ with the ‘programme.’ The psychiatric treatment programme was twofold in its approach, consisting of the administration of antidepressant drugs to combat the depression, together with what was basically a feeding schedule. At first, Chris had refused to take part in that schedule, using every ruse imaginable to trick the staff into believing she was complying. Eventually, however, she realized she must eat, and eat substantially, in order to get out and to get home. I was enlisted to bring huge quantities of bananas into hospital for Chris, who throughout, still insisted her heightened sense of smell prevented her from eating much else. Apart from the bananas and toast, which she could tolerate, she ate little else, and on these alone her weight increased to eight stone plus, a point at which the staff considered her ‘safe.’ Chris was discharged shortly before Christmas, after spending only three months detained under section 3, but bringing the total time spent in both hospitals to nearly five months.
Despair
Sadly, the whole thing had been a ruse, a means to an end which, once achieved, allowed Chris to continue her anorexic lifestyle in peace. The truth was that nothing had changed and semi-starvation, hyperactivity and weight loss resumed as the new year unfolded, despite a number of new factors entering the equation. Following discharge, Chris had been encouraged to take part in some of the activities at a local day centre, as a continuation of the occupational therapy which she had received whilst an in-patient. In Addition, she began to see a social worker for an hour’s counselling each week at the local social services centre, and this, together with a weekly home visit from a second social worker put a much needed monitoring regime in place. The social workers befriended Chris, who responded to their counselling with intimate confidences about her innermost fears, seeming to make some headway with their help. In the face of remorseless continuing deterioration and the return of suicidal inclinations, it was the advice and counsel of these new friends, which persuaded Chris to agree to a voluntary re-admission to hospital in the early spring. Chris had believed that going into hospital was to be for a fortnight or so, but this is hardly ever the case with psychiatric admissions, and the fears of the social workers were soon confirmed as the following entry in her diary reveals:
Had a bad night last night, intended to take the aspirin at about 9.30. I was very