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“I was so disappointed in myself; I wanted so badly not to be among those who relapse. But I was also afraid that people would be disappointed in me.”
Mathilde was admitted a second time to the same hospital, this time for two weeks and with a little bit more freedom.
“I was allowed to have visitors, to keep my phone and my laptop. Because, this time, I told them I wasn’t in denial, I knew I needed help and I was the one reaching out to get it. I wanted us to find solutions together. They wanted me to go back to the psychiatric ward, but for me that was out of the question.”
“This time, it was important for me to take an active part in my treatment, for myself, not merely to please others.”
Mathilde explains that she wanted to avoid the psychiatric ward at all costs; that what she wanted was to receive help in her own environment, at home. They told her that the recovery process would take much longer. “I said I’ll take the odds; I needed them to trust me and they did, and I think that was the right decision.” She left the hospital with a strict plan that included a minimum weight — were she to drop below that weight, she’d have to head back to the psych ward.
“This time, it was important for me to take an active part in my treatment, for myself, not merely to please others. I really wanted to understand; so I was willing to put in a lot of effort.”
For Alain Perroud, this new mindset in which Mathilde found herself after her relapse is essential to fully recover from anorexia: “Recovery won’t come from the doctors curing the patient; it is the patient who will heal themselves if they are conscious of being ill and that the illness puts their life at risk.”
“The second time I was discharged,” Mathilde explains, “it was my birthday. The first thing I asked was to go and eat cake, to mark the occasion. And unlike the first time, I didn’t think being discharged meant I was out of the woods. I thought, ‘Okay, now it begins.’ This new mindset was really helpful because I acknowledged that I was ill and that I couldn’t pretend nothing was wrong.”
Mathilde was ready to “fight the war”, even though she had no idea how long it would last. Sometimes it seemed to her that she would never get better. “I went through episodes of despair when I thought I would never be able to recover, to the point that I briefly considered accepting my life as it was.”
How are you supposed to be patient when you’re 23? How do you set your fervor aside for an illness that is eating you alive? How do you forgive, forgive yourself for your mistakes, for wasting those years of character building because of your brain that is ill?”
Although Mathilde chose to recover at home, her daily life was filled with appointments: she was monitored by her psychiatrist, her GP and a nutritionist. The frequency of the appointments was adjusted depending on how she was doing, whether she was making progress or suffering a relapse. But overall, it lasted five years. After trying psychoanalysis — which she found unhelpful and quit — Mathilde also reached out to a therapist who suggested systemic therapy. “That was life-saving for me. Rather than attempting to determine past causes, it focuses on the present and the situations you find yourself in, and aims to provide tools that will help you feel better in the moment before confronting the rest.”
I ask Mathilde about what happens in a session. “The therapist talks just as much as the patient, so it’s a real dialogue. Sometimes we would use drawings, exercises — visual things that are then discussed with the therapist who wants to make sure she understands what you bring to the session. What I liked was that it was so practical: I could talk about a concrete situation that upset me, and we would talk it through to find a solution together and to see how this could be applied to other situations. It’s like progressively building a shield.”
Alain Perroud outlines a few more features of systemic therapy: “The aim is to help the patient improve their relationship with others, by reflecting on the way they communicate and on their place in the family. This approach is especially relevant when the person suffering from anorexia is socially dependent on others — for example when they live at home with their family. The most interesting model for this therapy is perhaps what is called interpersonal therapy, which isn’t very common in France but is widely practiced in Anglo-American countries. The focus on relationships can tackle grief, changes in role, life transitions, feelings of loneliness… These issues can all be successfully addressed through this type of therapy for people with anorexia.”
Mathilde’s diary reads: “The work we do in therapy is beneficial but tiresome. It impacts my relationships with others; I need to destroy everything in order to rebuild everything.”
“Sometimes, I feel like I have found myself; but sometimes, I feel lost.”
“I cry, I feel lonely, misunderstood.”
“Sadness and melancholy always seem to be there; feelings that I had almost forgotten, that gave way to anger. I am angry, I feel like a victim struggling to find solutions, impatient. How are you supposed to be patient when you’re 23? How do you set your fervor aside for an illness that is eating you alive? How do you forgive, forgive yourself for your mistakes, for wasting those years of character building because of your brain that is ill?”
Interpersonal therapy. Relationships with others. I notice that Alain Perroud talks a lot about the role of the family in this type of therapy. I feel slightly surprised, for Mathilde hasn’t really talked about her family. I ask her about it and she tells me that she did have a few sessions with her parents. I notice that we hardly talked about how her parents might have played a part in the development of her illness. At this point, I have to admit that, when I was researching anorexia, it often came up that a toxic relationship with the mother could be a contributing factor. I wondered if there was a problem with her parents.
One day, as we are going through her notebooks, we find cards and letters sent by her family when she was in the hospital. I take the opportunity to ask her about it. She picks up a postcard from her father: “He just wrote this quote: ‘Children absorb the fear, the sorrow and the anxiety of adults.’” “Do you think your dad felt guilty, about your illness?” I ask her. “Well I think he reconsidered a lot of things about my childhood. But guilt and blame are pointless.” I ask her about her mother then. “I guess she felt bad about it,” Mathilde says, “just like every parent feels bad when something happens to their child — especially with mental illnesses. Because mental health isn’t as discussed as physical health; there is the belief that people suffering from a mental illness can control it. Sometimes you think that none of this would have happened if x thing hadn’t been done or said to trigger it — but it’s like History, we don’t actually know. It is a complex combination of personality, environmental factors and social relationships. It’s too easy to put the blame on parents when really it’s much more complex than that. But yes, I think they agonized over that, because of this bias that ties mental illness to ‘bad parents’. I find it really harsh, because there is no such a thing as ‘the perfect parent’, only people doing the best they can with what they have. My parents were very loving and overall really good parents that stuck by my side through everything.”
Apparently my assumptions were wrong. I questioned Alain Perroud about these preconceived notions regarding toxic family relationships and anorexia. “It has been hotly debated for the past forty years. In the 1970s, it was thought that the family was both the trigger of and the fuel for the illness. A systemic approach went as far as to consider the illness a mere symptom of a dysfunctioning family. To be clear, these notions were disqualified. Studies never proved that the hypotheses about overprotective mothers or absent fathers were relevant. The paradoxical conclusion of recent studies on the relationship between the family and anorexia nervosa, is that the more the family is proven to play a small-minimal role in the problem, the more the family is proven to play a big-major role in its resolution.”
“I kept pretending everything was fine, until my mind found another way to express my feelings. This is how I understand it.”
About a year after her relapse, thanks to therapy and the support of her loved ones, Mathilde began to feel better. She got a job in a performing arts center — and that was where we met. Today she acknowledges how beneficial it has been for her, to find her place in a professional setting where she felt good. “It really helped me to socialize again and to be more than my illness. I made a lot of friends there and I can’t thank them enough. I don’t know if they realize how helpful and precious it has been, to be able to meet people, to chat with them, to just be with them and to see people laughing…”
In this new life, for the first time in ages, Mathilde not only feels better, she feels good. She also understands many things about the disorder. “The way I see it, I had been quiet for too long, I didn’t want to talk about it and kept pretending everything was fine, until my mind found another way to express my feelings. This is how I understand it. It had to be released, to be visible, and because I couldn’t find the words, it was translated through anorexia and weight loss.”
“When you were 20, at the time when you became ill,” I ask her, “what was your vision of a successful life?” She says she had no idea, or rather that her idea of a successful life didn't fit what is usually expected of you when you are in your twenties. “I pictured having someone you love by your side, spending time with your loved ones, and having a job you’re interested in. But really, at the time, it wasn’t so much about work; it really was about the people dear to me, my friends and my family, and I thought it was a problem. I thought I lacked ambition and perhaps it meant that I wasn’t good enough. Even now my vision of a successful life is the same — but now I fully accept it. When I was 20, I didn’t accept it, because for one thing it wasn’t what would bring me money, it wasn’t enough with regard to society. I didn’t have the maturity yet to acknowledge that what mattered was whether or not it was enough for me. Now, the difference is that I know which life I want and move towards it. When something makes me happy, that’s what I go towards. And just this, for me is proof of being healed.”
“I’ve always been scared that fighting anorexia might become my whole identity. After the fight, what do I become? What purpose do I have? This war I’m fighting takes a lot of time and space, it is a part of who I am; I’m becoming an adult because of it.”
“I want to shout how happy I am to be alive, my joy when I feel it, my youth. Of course everything will come in due time. More than anything, I want to feel good and at peace.
“I don’t know if I can come back to that race. But do I really want to play by the rules? What if I don’t resume my education? What if I don’t succeed in achieving what I want? I don’t even want to think about it.”
“To find the right words to describe your feelings or emotions is still one of the hardest tasks I know of. If one day I manage to do it, I would have already won so much.”
After all this time, Mathilde can say it loud and clear: her difficult journey ultimately helped her to overcome her deepest fears and gave her the strength to live the life she wants to live. She talks about how, when you are 20, you regard failure as something inacceptable, something that is to be feared. “No one tells you that sometimes, failing at something becomes the ground you will be able to flourish on later. And this is something you tend to learn very late in life. Some of my friends who are between 26 and 35 are still really scared of failure, whereas I see failure as an opportunity to learn something and grow. Falling down doesn’t mean you will die from it. When you’re 20, you think that if you fall down, you will die. I was so afraid that I really did fall down, in the end, but at least now I’m no longer afraid.”
“Do you think recovery brought you the ability to appreciate the moment?” I ask Mathilde. “That’s what I’ve been doing these past four years,” she laughs. “It seemed like such a long day, suffering from anorexia, as if time had stopped, a day that never seemed to end. So now, I’m really more attuned to the present, to the immediacy of life. Everything I went through showed me I wasn’t invincible like I thought I was, and with that came the fear of not having lived the life I want to live. Those five years I spent consumed with anorexia, I will never get them back. And I don’t want to live like that anymore, I don’t want to wonder, ‘Will I be able to make up for this lost time?’ — I just want to live in the moment when it comes. I don’t want to have regrets.”
“I focus on the present moment and on taking part in life — because I have so much better to do! There’s more to life than being miserable about your appearance. To be honest, I prefer how I used to look, but I feel so much better now that it doesn’t matter anymore.”
To a certain extent, Mathilde was lucky: her life was turned upside down for five years, but she managed to get back to a ‘normal life’ pretty quickly. Alain Perroud underlines how time consuming the illness is: “Suffering from anorexia nervosa can take up between three or five years of a person’s life, sometimes even a decade, and it takes a lot of time to recover from it. Their social life, relationships, and personal development will be put on hold during that time. This is why it is so hard in recovery to get back to those things, to find your place, find your purpose, to have a career and romantic relationships. Recovery is followed by a period of time when the individual is at risk of relapsing and needs to find a sense of stability.”
“When did you consider yourself healed?” is my next question to Mathilde. “When I started struggling with stuff that involved my emotions and that I did not restrict my food intake. Also, when I gained some weight back and didn't cry. It annoyed me, but I didn’t cry and I didn’t act on it.
According to Alain Perroud, between 60% and 80% of people who suffered from anorexia are able to recover without lasting harm. I ask Mathilde about the traces of the illness that she still carries with her: “I’m still somewhere between passion/repulsion. I enjoy eating, but the less time I spend thinking about it and about what we’re going to eat, the better. I eat when I’m hungry. I still remember the calories, but it doesn’t affect me anymore. I no longer want to intellectualize food.”
“When I look at pictures of myself at 18 years old, I have the feeling that we have been several persons, taking turns living our life, one after the other. I can’t find a link between myself and this girl. She has curves, she’s laughing, she has her whole life ahead of her, and I’m pretty sure that, at 18, she believes in life. She has a lot of expectations about higher education, and about the world that is opening up to her. I’m afraid I have let her down. I can’t seem to establish a connection between each fragment of the girl I was.”
Today, Mathilde still has a distorted vision of her body, but she decided to not let body image be an issue. “Even if I don’t like the way I look, I go beyond that; I focus on the present moment and on taking part in life — because I have so much better to do! There’s more to life than being miserable about your appearance. To be honest, I prefer how I used to look, but I feel so much better now that it doesn’t matter anymore.”
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