I write about each stage because it might help others to know exactly what an eating disorder programme looks like, although every unit varies.
L still has to eat three meals and snacks each day, within time limits. She can now choose her meals from the two or three choices available. She is anxious about this and it takes me a while to understand that this means she is choosing to eat rather than being fed. Even though the choices will all be similar (funnily enough, there are no options of green salad with a slice of chicken, L’s meal of choice at the height of her illness) it means she will choose the food and have to stand up to her eating disorder.
She and the nurse have made a plan. She will choose breakfast today, breakfast and lunch tomorrow and all three meals on Sunday. She talks to me about this and seems confident. Her team are also putting together a therapy plan to address her triggers and to help her understand the root of her illness so she can banish it or at least control it. But I already notice a change. She has a weight chart and targets which show the weight she is aiming for to get to Stages 3 and 4. This is a major step forward. Before we talked of ‘getting better’ and recovery without mentioning the whole weight gain thing. But now L points to 55kg as her target and how long it will take her to get there. She shows me on the chart that she could be 74kg and still be a healthy weight. But obviously that would be too far. I don’t tell her that this is about what I weigh. I tell her how amazing she is to have come this far and to have done so well. C also comments that she looks so much better and points out how her collar bones are not sticking out. I freeze slightly. Does L need to be told quite so bluntly? So I show her two photos on my iPad, both of which are on her Facebook page. Both show a beautiful young woman, but one looks healthier and happier. I get her to admit how lovely she looks when well. Other signs of her improvement is that she tells me she sometimes feels hungry outside of snack or meal time. This really is a breakthrough. Of course anorexics are always hungry, but never admit it. Hunger is turned by Ed into the signal of feeling great and being in control. Being hungry, but not eating and pushing that feeling as far as possible. For L to say out loud, when eating as much as she is, that she sometimes feels hungry, is a huge step forward.
L can now commence an education programme once school starts, in the unit’s small school. She can have 3 20 minute walks each week. As her weight increases she can do more and her target in her care plan is to be able to play tennis. It is great that her care plan defines recovery in terms of getting a life back rather than points on a weight chart. Both L and I have copies of her plan and she has a folder, with the plan, with workbooks on mental health, her rights as a young person and the challenges she faces. She shows me all of these and I smile at how pleased she is with her neatly ordered folder.
One part of her care plan is about her capacity to consent to treatment. L is assessed as ‘Gillick Competent’ (remember Victoria Gillick?) which means the staff believe she is sufficiently mature to consent to treatment. The care plan details what would happen if she withdrew consent and also if she decided to leave the unit. It describes a process of persuading her to stay, then asking her to wait until we come to collect her and finally if she leaves the unit alone, how we must be contacted as well as the police, for L’s safety.
This part of the plan was read out to me by L’s nurse earlier that day. I listened politely and at the end said, “We both know L is never going to run off like that, don’t we?”. We laughed, at the thought of this delightful, well mannered, obedient young woman doing such a thing. And then I said that actually L needed to rebel a bit more. She needed to stop being so bloody lovely to everyone, to be a bit of a cow occasionally, to be awkward and difficult, to be the kind of person that neither Ed, nor anyone else can push around. That will need to be part of her recovery and the L that emerges might be more challenging, less biddable, less keen to help everyone around her and perhaps a bit more selfish. Friends have always sighed with envy about the loveliness of L, especially compared to their own teenagers. But the truth is, I think, that if L was a little more like their teenagers, Ed might never have got a grip on her. I look forward to L being better, perhaps I need to look forward to her rebelling against me too.