“As long as there is food on this planet, I am going to have this illness.”
As a child Mary was happy: she enjoyed playing with toys and spending time with her sisters. But, when she was just 16 years old, she split up with her boyfriend, she was bullied at school and her relationship with her sisters broke down.
Mary decided to go on a diet to regain some form of control over her life. The diet soon spiralled out of control and she developed anorexia nervosa and chronic obsessive compulsive disorder (OCD), starving herself as a way of expressing the unhappiness she was feeling.
Three months later, underweight and malnourished, she was admitted to hospital with suspected heart failure.
Eating disorders are complex illnesses with potentially life threatening consequences. Anorexia is not just an out of control diet, it consumes the individuals’ self-esteem and confidence. It is often triggered by abuse, the need for control and a lack of communication with family. Taking control of food and body shape may be the only thing the sufferer believes they can influence.
Mary said: “I was an active child and always a perfectionist. I was always quite slim but I wanted to be thinner. I felt insecure and being in control of my weight gave me back some security.
"I thought about the terror of putting on weight and I used to think that as long as there is food on this planet I am going to have this illness.”
Body mass index (BMI) is used by medical professionals to determine a person’s weight in relation to their height. The average BMI for a healthy adult should be 20-25. At the age of 45, Mary’s BMI was 11.3 and she weighed just four and a half stone.
Mary said: “I limited myself to a quarter of a yogurt and a few segments of orange and I would try and walk eight miles every day. I went hyperactive and felt terrible. I just wanted to die.”
Throughout her 20s and 30s Mary had fallen into the trap of being institutionalised. Her life consisted of repeated admissions to hospital and constantly being fed-up to a target weight only to go and lose it all shortly after she went home. She had a history of self-harm and had attempted suicide. Her consultant at the time described her condition as incurable.
Mary was on a downward spiral. But then staff working at Care UK's Althea Park specialist care services were asked to visit Mary and assess her condition. Katie Holmes, a senior practitioner, and her team doubted whether everything had been done to help. Katie said “Mary’s weight was at a dangerously low level and, if she didn’t break away from the hospital and get alternative help soon, she would die.”
Mary was quickly referred to Ashleigh House, Gloucestershire, with Katie as her case manager. Ashleigh House is part of a collection of facilities at Althea Park specialist care services. It is a six-bed residential home offering help to adult women suffering from enduring eating disorders and related illnesses, such as histories of depression, obsessive compulsive disorder or self-injury, as well as multi-impulsive and borderline personality issues. It is a mid to long-term care home, with the minimum stay being six months and the maximum stay being two years.
The person-centred approach at Ashleigh House is different to the intensive re-feeding treatment used in hospitals. Care UK offers a therapeutic programme designed to meet the needs of adult women who, despite repeat interventions from other specialist eating disorder units, fail to respond to treatment and repeatedly relapse.
Mary constantly fought against the re-feeding process at hospital. She said: “Hospital was terrible. I wasn’t allowed to see my family, and they forced me to eat three meals a day as well as snacks.”
Katie added: “For some people, being in an intensive hospital environment works, but not for Mary. She was constantly admitted to hospitals which had the same regime for every patient. At Care UK we regard wellness and nutrition as central - recovery cannot be achieved by re-feeding alone.”
Some of the women who are referred to Ashleigh House see their disorder as their entire identity and often they cannot comprehend a life not dominated by food, body image, exercise and purging. Katie added “Treating an eating disorder is a bit like balancing plates, you have to work on every underlying issue simultaneously rather than managing just one.”
On admission to Ashleigh House Mary was extremely emaciated: her muscles were wasting away, she was too frail to walk by herself and she was wheelchair bound. As routine procedure, a personalised care plan was created for Mary and she required round the clock nursing care. Katie said: “Mary was one of the most severe cases I have ever seen. She was a chronic exerciser and, when she became fitter, she wanted to go outside for walks, sometimes walking for miles and miles. Her main fear was putting on weight quickly, so we worked with her to set boundaries and helped her to understand calorie control.”
As well as having an enduring eating disorder, Mary’s OCD was taking over her life. She would ritualistically check every item in her room, making sure they were in the perfect place, putting lids down, brushing her hair and opening and closing the curtains all day. She would become verbally aggressive if any of her care plans interfered with her rituals.
Mary added: “For 18 hours of the day my life was consumed by rituals and obsession, I felt awful.”
Mary’s condition progressed and she was well enough to attend weekly art therapist sessions and individual psychotherapy meetings to carefully address some of her underlying issues.
At Ashleigh House, real-life successes are an integral part of treating eating disorders. Every social opportunity is maximised according to what the client’s physical and mental state will allow. By encouraging individuals to engage in further education, work and socialising, they can take on their underlying motivation to recover and build on their self-esteem.
Katie commented: “We call this 'therapy in the living'. We try to ensure that each individual, regardless of their difficulties, can experience a non-institutionalised environment, both in terms of a warm and comfortable home setting, and through positive and therapeutic relationships with staff.
Initially Mary and her care team agreed to a half a kilogram weight gain per month, with a rest period at a BMI of 15, in the hope that she was able to maintain the weight.
Regular holidays and outings are also encouraged at Ashleigh House. Katie said “We want our clients to experience life as enjoyable and fulfilling as possible as it is essential to motivate and sustain recovery.”
Mary attended the unit holiday where she went horse riding, cycling, and abseiling. She also went out every day with staff to establish some confidence and to address her social anxiety. Over a period of time Mary started to form meaningful relationships with the staff and she started to see that progression was attainable.
Katie added: “Mary felt physically safe and secure at Ashleigh House. If she felt she couldn’t achieve something on her care plan, we would talk through and negotiate it with her and constantly review the plan as she progressed.”
Some of the care team escorted Mary home for leave, to ensure the relationship with her family was encouraged. They stayed in a local bed and breakfast and visited her at home to help her with meals to ensure progress was not lost.
Mary started to become more in control of her OCD and was able to sustain her weight. She had developed friendships with some of the women living at Ashleigh House and she became interested in the outside world again. She commented: “Ashleigh House is a lovely and warm place, I got on with all the other girls, the staff were caring and understanding and they didn’t interfere with me when I wanted to be left alone. I can’t praise them enough. Ashleigh House saved my life.”
Following a 30 year battle with anorexia, Mary was discharged from Ashleigh House after just 18 months. She was discharged with a BMI of 16.4 which she was able to manage and further progress.
Katie said: “I was really pleased for her and proud of what she achieved. She used all the unique care and support that was offered and she worked extremely hard.”
Mary now weighs seven stone and has a BMI of 17.6. She lives at home with her father, has meaningful relationships with her sisters, wears make-up, has a long-term boyfriend and has a job in a sweet shop.
Although she describes her progress as ‘slow recovery in the making’ she has now almost completely got her OCD under control.
Mary added: “I am loads better, I go out, I have a job which I love, and my mood is lifted. I owe so much to Ashleigh House. I used to doubt myself all the time, but now I don’t. They’ve done so much for me.”
The first Christmas after Mary was able to move home, her sisters sent the care staff a present and letter saying: “Thanks for getting us our sister back.”
Mary commented: “I feel like I have had a brain transplant, I feel totally different. I am now interested in clothes and I enjoy eating food and tasting all the different flavours - my favourite food is ice cream. I prepare meals for myself and my father and I like going into restaurants.
"I have been poorly for 31 years of my life. It’s depressing thinking back on all the years I have lost, but now I am going to live my life to the full and it's all thanks to Ashleigh House.”
