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“I wasn’t feeling good about myself when I became ill, and so feeling a bit of self-confidence, of safety and control over my life, that was something that was really hard to let go of.”
Mathilde describes how she felt during the first months of her illness. “The vicious aspect of the cycle is the same as with drug use, because when you experience those sensations, you don’t want them to stop, so you keep going, further and further. Like a drug addict who needs to increase the dose in order to really feel it. You feel lighter, you feel good, as if ‘cleaned’, more peaceful. At least in the beginning, I was only experiencing pleasant sensations — which is why this illness is so insidious.”
To talk about the first months of anorexia, Mathilde uses the following expression: “the honeymoon.” “It was like meeting a new friend, toxic though she may be, but it’s the phase when she becomes your closest friend, you know?”
Psychiatrist Alain Perroud explains: “The emotional experience of the illness is very particular. The first phase of the experience is like a honeymoon when things still feel pleasant, and even thrilling: there is a sense of exhilaration that comes with being able to restrict your food intake and lose weight. These positive sensations are fueled by the praise coming from other people, but they also stem from a biological phenomenon: the process through which stored fat is burned. Ketone bodies are released, which produces an exciting effect on the brain. That is one of the reasons why the early stage of the illness is often suffused with pleasant sensations.”
The thrill of restriction is familiar to Mathilde, who simultaneously developed a form of hyperactivity, sleeping less and feeling the need to move more. “I had never had more energy than at this time of my life,” she says, “which does not help you realize that you are ill. Your body is always in motion, even when I was seated I could not remain still. I would walk a lot and stopped using public transport, no matter the weather.”
“When I started to count calories, it wasn’t even about whether it was composed of fat or carbs or anything, it was just about the numbers, and the control I got from it.”
Alain Perroud explains that this hyperactivity is linked to several phenomena that come with rapid weight loss: “The need to keep moving becomes an obsession. People fear that they might produce more fat if they stay put, and regain weight. Another hypothesis would be that hyperactivity is brought on as an instinctive response because it increases internal body temperature, which counteracts the constant cold experienced by people who are malnourished and underweight. A more phylogenetic hypothesis is that we possess a predisposition to hyperactivity when food is lacking: the brain experiences restriction as famine, which produces the same response that was probably a defense mechanism when food was scarce and humans needed to stay active to try and find food.”
Mathilde proceeds to explain how she would view her food intake through the lens of calories. “When I started to count calories, it wasn’t even about whether it was composed of fat or carbs or anything, it was just about the numbers, and the control I got from it. This is one of the lingering effects of the illness I still experience today. It wasn’t about the food anymore; it was about adding numbers and trying to get the sum to be as small as possible. My meals were carefully measured; I would eat very slowly and drink a lot of diet soda.”
At this point in our discussion, the clock hits noon, we’re getting hungry and we need to go to the supermarket to buy something to eat. Mathilde uses the opportunity to explain how shopping at the supermarket went for her when she was ill. At the time, the process involved a lot of staring at the items, picking up things to read through the nutritional information — especially calories, quantities of fats and sugar — before putting them back on the shelves, sometimes coming back to them to take another look… And the operation could repeat itself on and on for hours. There were even times when she’d spend a full hour in the supermarket and overthink everything so much that she would end up buying nothing at all. She also mentions another lasting consequence of anorexia: “The reason why I only buy soy cream is that my stomach can no longer process cream. That’s what happens when you cut out food groups from your diet.” Ready-made meals were out of the question: “This is why I started to cook everything myself; because with ready-made meals, you have no way of knowing what they put in it.” The section dedicated to cakes and snacks was very familiar to her: “I knew I wouldn’t buy any of them, but I would eye them and touch them every time.” She would only allow low-calorie portions she could control.
As we have seen, control is a major part of anorexia — Mathilde even talks about hypercontrol. “First it applies to food, but soon enough it covers your whole day: how long you’ll sleep, how many steps you’ll take, how much you’ll exercise, as well as very detailed study plans. Just like I counted calories, I calculated my time.”
Sociologist Claire Scodellaro explains: “With anorexia, behaviors seek to reach social excellence even beyond physical appearance. Especially girls and young women with anorexia, in school or higher education, are more prone to overachieving and striving for academic success.”
In Mathilde’s story so far, it is clear that she lacked self-confidence and took things very seriously. She displayed the main contributing factors to anorexia nervosa, as presented by Alain Perroud: in addition to a potential genetic predisposition, people with anorexia often suffer from anxiety and tend to be perfectionists. Anorexia reveals their need for control and enables them to take it to the extreme.
I ask Mathilde how she handled hunger and frustration. “In the first months, I was really hungry,” she admits. “But at some point, it’s almost as if the moment had passed. If you eat, you realize that you’re hungry, but when you are ill, you are so deep in hypercontrol, so scared to give in, that you just don’t. There was this voice in my head telling me that if I could hold on, it would be worth it. I would intellectualize my hunger, touching food, taking in the smells, but not eating it. The food might not go into your body, but would be present everywhere else, especially in your mind. I was constantly thinking about it. Every moment of my life was ruled by thoughts about food.”
“Control gets out of control; which is precisely the reason why it is a pathology. Even when they are encouraged to eat more, they cannot simply let go of their rules.”
Soon enough, Mathilde’s rapid weight loss caused concern among her relatives. She mentions her BMI. The body mass index is a tool that can be used to broadly categorize a person from underweight to obese, calculating their body fat percentage from their height and weight. After six months with anorexia, Mathilde’s BMI fell into the category of “extremely underweight” and malnutrition. Her obsessional cycle of restriction rapidly began to have a serious impact on her relationships with her friends and family. Today, she acknowledges their support, but also realizes how sad and helpless they felt. She had grown withdrawn, sullen and irritable, only caring about losing weight and performing her rituals. The euphoria of the first months was wearing off, replaced by constant angst and loneliness. Alain Perroud evokes a feeling of failure: “Suddenly, weight loss does not happen as easily; the praise you previously received turns into disapproval. You get consumed with the fear of regaining all the weight and canceling your efforts. Studies have shown that a severe or rapid weight loss, because of food deprivation, can cause irritability, anxiety, depressive tendencies, and decreased tolerance or interest in human relationships.” And as Claire Scodellaro explains, people suffering from anorexia nervosa can’t simply break free from the cycle: “Control gets out of control; which is precisely the reason why it is a pathology. Even when they are encouraged to eat more, they cannot simply let go of their rules.”
One day, Mathilde experiences another symptom of the illness: amenorrhea. She no longer has her period. She brings herself to go and see an endocrinologist, who is the first to utter out loud a diagnosis that her relatives foresaw: Mathilde has anorexia nervosa; she is at risk of dying and needs to receive medical treatment. On the doctor’s order, she drops out of school.
When I ask her about how her body reacted at the time, Mathilde explains that her body was left to choose between her organs, shutting down what was not immediately vital. Sitting down became painful; she would bump into things more often; her stomach was bloated because of all the water and soda she drank — which, along with poor digestion, caused persistent stomachaches. “And I was cold all the time,” she adds. “I was freezing inside, chilled to the bone.”
Ultimately, Mathilde no longer has a choice: she doesn’t believe that she is ill, but she follows the advice of her doctors and family, who fear for her life. Being extremely underweight, her body taps into her muscles, including her heart, which might stop at any moment.
Within two days, her family and her then-boyfriend had driven her to the hospital where she was admitted. She says she didn’t realize what was happening until the very last moment, when she saw her loved ones turn at the end of the corridor, wave at her and disappear. Left alone in her room, Mathilde cried for the first time, the realization finally hitting her — ”This is it,” she thought.
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