I don’t remember most things I read in the Guardian yesterday, let alone eleven years ago. However, there is one piece from August 2001 that’s always stuck in my mind. Back then Julie Burchill had a column in the Weekend supplement, and it just so happened that one Saturday she decided to lay into people with pretend illnesses. You know the sort – alcoholism, depression, ME, anorexia – the kind of illnesses which might actually kill individuals, but which are, nevertheless, totally pretend.
In her carefully thought-out diatribe, Burchill muses on what pretend illness sufferers would do were they to find themselves marooned in a completely different environment: “a person with terminal cancer washed up alone on a desert island would still have terminal cancer and eventually die, but an alcoholic would no longer be an alcoholic in anything but name”. Well, yeah. There’d be no booze. This is unfortunate, since in such a setting, I imagine even the terminal cancer patient would appreciate the odd tipple. But hey, what about the anorexics, Julie? What would happen to them?
And what would anorexics do without an audience, do we think? If the desert island appeared to be barren, would they simply sit back, top up their tan and think happily, “Well, that’s all right, then – I’m going to die. Sorted!” Somehow I have the suspicion they’d be stuffing down grass, lizards and whatever they could grab as the good old survival instinct kicked in. On the other hand, if the island was blessed with a fine array of nature’s bounty, would they sit there obsessing, “Oh, there are a whopping 300 calories in half a shell of coconut milk, and 450 in a freshly roasted tuna fish – I think I’ll leave it and have a bit of this grass instead!” Like hell they would.
Now of course, you may read this and think it’s just someone who’s grown too lazy to think, let alone write, deciding to take a few cheap shots in order to outrage a liberal readership. You may think it’s the ravings of an ex-working-class bully who can’t get over her own relative lack of privilege and wants to show how, actually, it’s everyone else who isn’t allowed to suffer. You may think all that but hey, let’s follow the inexplicable example of countless broadsheets and still give Burchill a chance. After all, she may be on to something.
The desert island treatment sounds harsh, but is it any worse than what’s previously been offered to anorexia sufferers (or should that be “sufferers”)? It might be difficult to organise in practical terms – is the set used on Shipwrecked: Battle of the Islands still available? – but once we’d got over that, there’d be nothing else to stop us trialling such a treatment method. After all, there shouldn’t be any moral issues involved in packing someone off to a remote location against their will. It might sound extreme, but it’s not any worse than what’s been done to anorexics before.
To set things in a personal, middle-class and entirely self-obsessed context, I ought to mention that I was first hospitalised for anorexia in 1987, at the age of 12. Obviously I went straight to the famous Rhodes Farm clinic, run by Dr Dee Dawson. This provided a supportive community in which “sufferers” could share their imaginary woes and get nice food to eat in the bargain. Then in later years I went to the Priory… Actually, this is all complete bollocks. My anorexia was treated in a normal hospital on a normal children’s ward. The treatment involved two highly complex processes, which must have taken some medical researcher all of two seconds to come up with: force-feeding and the withholding of privileges. There was no psychiatric element because hey, Julie’s right and that’s all self-indulgent shit. Instead, I had a naso-gastric tube inserted (and forcibly re-inserted whenever I tried to remove it) and was denied certain privileges if I refused to eat or gain weight. Such privileges included Topshop vouchers, trips to the zoo, cinema outings … Actually, that’s all bollocks, too. Privileges were things like seeing my parents, having the light in the isolation ward switched on and staff being permitted to engage in conversation with me. I would, to be honest, rather have been plonked on a desert island. At least then I wouldn’t have had the fucking feeding tube. I had no “privileges” but I was getting fat anyhow. And so, eventually, I did start eating. In the long-term it offered the only possible route to having the tube removed and reducing my calorie intake again. Without wishing to get all middle-class and whiny (sorry, Julie!), I did find that whole experience rather traumatic, to be honest. It certainly didn’t stop me being an anorexia sufferer/”sufferer”. It made me heavier, in the short term, but it also made me a whole lot iller.
This weekend I found myself reading about the case of E, a woman in her thirties with severe anorexia who is refusing to eat. Against both her wishes and those of her parents, a judge has ruled that she must be force-fed, even though her chances of recovery remain exceptionally slim. Personally, I can’t see what the sodding point is. Send her to Julie’s desert island. It’ll do about as much good.
Reports into the case describe the treatment E faces as “invasive”. I don’t think that comes close to summing up how traumatic force-feeding will make what are, quite probably, the last few months of this woman’s life. To an anorexia sufferer force-feeding is a complete violation. It is not simply about being forced to live, or even about being “made fat”. It represents an absolute loss of bodily autonomy, and one that is public and lasting. I’d hesitate to compare it to rape but, hey, what the hell, I will. I can see the objections to this, not least in the idea that the anorexic is not in a position to offer or refuse consent to what happens to her. But I think this is crap. The anorexic is a person and one of the most difficult things about anorexia is that, try as one might, one cannot simply tease out and dismiss “anorexic” thoughts and behaviours without seeming to stamp out an entire personality.
In a brilliant blog post on the case, Sarah Ditum notes that “the disease isn’t external to E, it is in her and of her, and if she seems to speak with the voice of anorexia, that is her voice too and should be listened to”. I couldn’t agree more. I think E’s wishes should be respected. And yet I’m only in a position to think this because I’m not dead, and that may, perhaps, be because I was force-fed. Which is, to be honest, a bit of a bummer intellectually. But if I know one thing, it is that force-feeding, while it may have offered some physical support at a time of extreme crisis, did not make me better. On the contrary, it increased my levels of anxiety and fear. Moreover, the force-feeding itself was not without physical risks. When I finally did start to recover, many years later, it was when I entered treatment voluntarily as an adult, into a programme which expressly excluded the use of force-feeding methods.
The downside to this (because there has to be one) is that you run the risk of someone literally starving to death. Which, indeed, someone on my treatment programme did. Obviously she only did it for the attention. If she’d been on that desert island … Oh well, no point dwelling on what might have been. Meanwhile I got better, but it wasn’t easy. A long-term sufferer doesn’t stop being anorexic and become the person they would have been without anorexia. It’s like suggesting someone becomes the person they would have been if they’d been born in a different country, or to different parents, or without the same sense of humour or intellect. It’s impossible. You have to go through several years of not being sure whether you’re a person at all. During that time, not being anorexic is as bad as being anorexic. And that’s without everyone telling you how “well” (i.e. not like you) you now look every single day.
I find it hard to believe any of this is possible for someone like E, at this stage. But then, that’s not for me to decide. It should, surely, be for her. Except it’s been ruled that it’s not. Why didn’t anyone just go and ask Julie Burchill?