Now I’m humming Blur’s Parklife. Anyway, It’s occurred to me that 13 weeks after admission I haven’t really shared any details about day-to-day life in an eating disorders unit. To me, now, it’s become the norm, but to people outside this bizarre world it’s a strange and unknown tiny universe.
So how does it all work?
To start with, you have to understand that an eating disorder is a manifestation of control. Control over something that you can dictate, as a stand in for all the elements of life you can’t. (Yes, it can be much more complex than that, but I’d put a need for control somewhere in the mix for everyone.)
So, it stands to reason that an eating disorders unit is all about taking away that control over food and eating. It basically takes away responsibility, and then gradually gives it back to you again as you learn new habits and are ready to control the need to control.
So we live according to a rigid timetable of eating and snacks, activities and drugs. Resting and therapeutic conversations. You name it: there’s a rule about it.
You get used to the system. You get used to asking for the most basic of things (“Can I stand up to fetch so-and-so?”). You learn how to live within the confines of this relatively small, ten-bed ward, cheek by jowl with other people with food difficulties. And you just have to hope you won’t go completely batty in the process.
Let’s start with eating. When you arrive, you generally spend your first week on half portions. Because I hadn’t eaten solid food for so long (errrrrmm, all of 2017), I came in on what was my regular diet of fortisips and milky drinks, and had one-to-one meal times to build up to eating regular food again.
The day here is ruled by the eating timetable. Breakfast: 8.30am. Snack: 11am. Lunch: 1pm. Snack: 3.30pm. Dinner: 6pm. Snack: 8..30pm. And after every main meal we are supervised in sitting down in the obs/TV room for an hour; half an hour after each snack. That’s four and a half hours of sitting down a day, in a small room packed with emotion, conforming to rules about how you sit.
Here’s a taste of the rigidity.
Preparation for breakfast starts at 8.15am. You weigh out your chosen cereal, making sure the staff member has seen the scales are at zero. You choose a jug and make sure staff have seen it’s clean and dry (I hold mine upside down over my head to make a point), so nothing can dilute the milk. You measure your milk out and get it checked. You pour a glass of fruit juice up to the approved level. If you’re on a larger meal plan, there are more rules about toast and spreads; it goes on and on. We start at 8.30am regardless of whether everyone’s ready or not, and when you’ve finished, you show a staff member your empty bowl and glass and your finishing time is written down. Your obs hour starts from then.
Here’s my place at the table. I’ve tried to find things to anchor me to a reason to eat: photos of family and happier times, mint to act as a grounding scent, Play-doh and a tangle toy to fiddle with to stop me scratching my skin off when I feel as if I’m crawling with calories. And the day’s tongue-in-cheek motivator card (self help without the self helpiness). No, I never thought I’d be a decorated place setting person either. All I can say in my defence is that I am so desperate I will try anything.
The atmosphere in the dying room is always charged with tension. When you’re finished, but the 35 mins allowed for breakfast isn’t over, you have to sit with the horror of what you’ve done. Or, in my case, smell fresh mint, fiddle with a tangle toy and fold paper cranes – trying to let the waves of horror and guilt wash over me.
If you hesitate in your eating or become visibly distressed, then a staff member will come over to ask you what’s wrong (the whole world is caving in over a spoonful of Bran Flakes, for example), and will quietly offer reassurance, encouragement and tissues. Apart from mopping up tears, you’re not allowed tissues or paper towels at the table to prevent eating disorder behaviours. So it’s just tough if you’ve got sticky fingers.
If, when the meal time has finished – but you haven’t – everyone else leaves the room and a member staff will encourage you to have fortisips to replace the nutrition you’ve missed out on. Often this means having more calories than you would have had if you’d finished the meal. And this can feel punishing.
We do this time after time, day after day, week after week, month after month.
You gradually conquer one fear, and it might be replaced by a new one. Or you might move on to the next in the long line of issues and barriers you’ve built up around food. There’s always something. It’s never ‘okay’.
Monday is the worst day of the week, because it starts with weighing: it’s our own version of Sunday night fear, dreading what the scales will say. The expectation is a weight gain of one kilogram a week, which creates a Catch 22 situation: if you’ve gained a kilo or more you have to sit with all the feelings that brings, but if you’ve gained less than a kilo you’re facing a meal plan increase in the Tuesday ward round.
Weighing starts around 7.30am in pyjamas, and you have to have been to the toilet. The kitchen is locked at midnight – but that wouldn’t deter anyone seriously determined to water load. We gather, silent and anxious, in the obs room and wait as the agonisingly slow moments pass until a staff member sticks their head round the door and calls the first person through. The numbers on the scale set the tone for the day and follow you like a cloud, obscuring all thought and conversation.
There are tears. Shouting. Painful silence. Other forms of comfort and control – some harmful, but necessary. Or so it seems at the time. Monday breakfast is incredibly hard and struggles with eating are definitely more intense all day.
Mondays, bloody Mondays.
Just think what’s to come in the rest of the week…