The Skeleton Cupboard (21 page)

“I just want to be tiny. Small.”

Mollie helped me understand the anorexic mind. She wanted to be a wisp.

“It's a part of me that I hate but can't control. I want to be happy but can't until I am thin.”

“Mollie, wouldn't you say that you are already thin?”

She sighed. “Look at this.” Tiny little birdlike fingers plucked at the minutest layer of flesh covering bone. “Look, see that. It is just too gross.”

An entrenched dysfunctional belief of breathtaking magnitude; I wasn't sure my cognitive behavioral therapy skills were up to the task of helping Mollie shift it.

Mollie had started to have problems with food at school.

What began as a slight anxiety became a full-on phobia of the school lunch hall; the smell of the food would cause her to become dizzy and nauseated, and the sight of the dinner ladies made her retch. Eventually she couldn't go into the lunch hall at all and tried to hide in the library. Once they discovered that, the staff tried to make her take her meals in the nurse's room. It didn't help. The smell of the school food was intensified in the small confines of that office, and just being in there made her throw up. Her parents were called in and she was sent to see the first of many doctors. Three years on, Mollie was finally admitted as an inpatient to this unit.

She leaned her head back against the headboard and sighed. “So many doctors checking my blood, testing for allergies, sticking cameras down my throat.”

“Sounds grim.”

Mollie raised her eyebrows at me. “You have no idea.”

She shuffled up the bed slightly, the exertion causing small beads of perspiration.

“At first, my school was really supportive, but when all the tests showed nothing, they began to get really irritated with me. I remember a meeting with my parents where my headmistress and form teacher seemed frustrated with Mummy and Daddy that they couldn't make me just get on and eat at lunchtime like everyone else.”

“How did your parents react?”

“Well, seeing as I couldn't eat at home either, there wasn't much they could do about it.”

I imagined the helpless and frustrated adults trying to manage this quietly tough and determined girl who was immovable in her determination not to eat.

“At first I was put on a ‘behavior program.'” Mollie laughed wryly. “You know, incentives for eating small amounts, consequences for not—like I was some naughty kid who wasn't doing as she was told and needed to learn the rules.”

“Well, isn't eating a fundamental rule of survival?”

“That wasn't what they were worried about.”

“Who, your parents?”

“No, the school.”

“Well, I can imagine that it might have felt like that, but…”

“They were worried about other girls copying me. They said they didn't want my behavior to lead to an ‘epidemic' in the school, like I was a contagion they had to control or eradicate.”

“‘Eradicate' is a strong word, Mollie. What made you think that?”

I could feel her anger. Mollie began to flush.

She sighed and stroked the nasogastric tube lying across her body. “I felt patronized.”

“Why?”

Mollie fixed me with her eyes. “Because they were making me do something that I couldn't do.”

I shifted in my chair. “Sounds like it became a battle.”

Mollie smiled to herself. “You could say that.”

“But why? Surely everyone was concerned and just wanting to help you?”

Mollie started laughing, and the laughter became a coughing fit.

When she'd recovered, she met my gaze again. “Help me? How can it be help when you are being forced to do something you can't do?”

I paused as I sensed a battle between us beginning. “You couldn't eat, Mollie, or you wouldn't?”

Mollie closed her eyes and sighed.

“Why the sigh?”

She shrugged her shoulders.

“Have you had this conversation many times before?”

Mollie nodded.

“OK. So how can we have it differently?”

Mollie opened her eyes. “You tell me—you're the psychologist.”

*   *   *

Mollie's parents came in every day—her father was loud and charming, her mother well coiffed and reserved. They sat by her bed and held her hands as they chatted about their days and asked her about hers; they loved their daughter. This well-functioning family with such a troubled child confused me.

One bright Friday afternoon, sun streaming in through the windows in Mollie's half of the ward, we introduced ourselves.

“Robert. I'm dad.” A firm handshake and a warm smile.

“Good afternoon. I'm Eleanor.” A small, thin smile.

“She's my mother.”

I drew the curtain around Mollie's bed and pulled up a chair.

“So,” said Robert, his voice and size filling our tiny space, “when will you get this little minx to bloody eat?”

Mollie winced. “Dad…”

Robert ignored his daughter and continued, “Seriously. I know this wanting-to-be-thin thing is all the fashion these days—our other two girls were the same, but not to this degree.”

Eleanor cut in. “Robert, neither Poppy nor Tilly had anorexia nervosa. It's different.” She leaned forward and stroked her daughter's tiny hand.

Robert laughed. “Oh, here we go again. Dad just not getting it! Sorry—I suppose I'm one of those old fuddy-duddies of the ‘just get on with it' generation.”

Mollie closed her eyes and squeezed her mother's hand.

Robert continued, “I mean, surely a label like anorexia, or whatever you all want to call it, just makes it valid and allows a person to give in to it.”

“Robert!” Eleanor's tone was sharp.

Robert sighed loudly and sat back in his chair. “Sorry, love. Me being a bull in a china shop yet again.”

The silence felt tense, so I decided to jump in.

“Mollie, you've got two sisters. Tell me about your family.”

Eleanor shot a look at me. “Surely you've read the notes?”

She was an understandably protective mother of a very ill daughter.

“I have, Eleanor, but I would love to talk this through as I get to know all of you.”

Eleanor looked at her daughter, whose eyes were still closed. “Shall I speak, darling? Are you too tired?”

Robert thumped his chair arm abruptly. “For God's sake, love, let the girl talk. Mollie, please answer the question.”

With eyes still shut, Mollie spoke. “My eldest sister is Poppy. She's twenty-eight and is a finance director. Then there's my brother, Rupert, who's a barrister. He's twenty-six. Tilly is twenty-five, and she's in the US doing her doctorate in international politics.”

Robert patted Mollie's hand vigorously. “Well done, darling.”

“Robert. Gently, please.”

“It's OK, Mummy.”

“So, Mollie, there's quite an age gap between you and your siblings.”

Before she could reply, Robert spoke again. “Ah yes. You're our little bonus ball, aren't you, love?”

Mollie smiled and looked at her father. “I am, Daddy.”

Robert beamed; he clearly adored his daughter. “Yes, and this little bonus ball is going to be the most successful of all, aren't you, love? My little girl off to train and be a doctor.”

Mollie smiled at her father, whose voice boomed on.

“Once we get some flesh on those bones, of course!”

Robert guffawed. Eleanor remained stony-faced. Mollie closed her eyes.

It was feeling increasingly tense in our little curtained-off enclave.

“Robert, I understand your concerns about Mollie's weight, but I wonder whether we need to think past that and consider
why
she is so afraid to feed herself.”

The booming voice now conveyed irritation. “Oh, come on. Let's not overcomplicate matters. With all due respect, we've had conversations like this for the last”—he looked at his wife—“how many years, love?”

Eleanor's tone was terse. “Three.”

“Yes, three years. We've seen this bloody therapist and that one. Family therapy, Mollie has seen counselors, had outpatient treatment…” His voice trailed off, his face red.

“I can understand—”

“No. With respect, you can't. Our daughter needs someone to talk some sense into her and get her eating again. What's it called? Refeeding. Yes, that's it. Refeed her and help her learn to feed herself so she can get on with her life. No diagnosis, just some good old-fashioned ‘pull your socks up and get on with it' therapy.”

I turned to Eleanor. “Do you agree with your husband?”

Eleanor, a remarkably beautiful woman, stayed composed as she stroked her daughter's hand.

“Mummy just wants me better, don't you, Mummy?”

Eleanor smiled at her daughter. “I do, my darling. And so does your father.”

*   *   *

Chris was tucking into a ciabatta. It was a big sandwich. Some of it spilled onto her blouse.

“Bloody hell, look at me! I'm the one with the eating problems!”

I laughed and sipped my coffee. At last the woman was demonstrating insight.

“So, what are your placement goals?”

Goals? Oh shit, here we go again.

“Well, I thought it would be helpful to review what I have learned across the other placements and look at what I need to get some more experience of in this one.”

Chris munched on and nodded. “Well said. Also how's the dissertation coming on?”

Bloody dissertation.
As if the clinical placements, case study reports, lectures, essays and termly exams weren't enough, I also needed to start my thirty-thousand-word dissertation, which was due at the end of my final year of training in order to qualify.

“Bloody dissertation.”

Chris smiled. She seemed in top form. “Yep, but got to be done. Have you made a decision on your subject yet?”

I hadn't. I shifted in my seat. “I've been thinking about studying the treatment of stimulant users in an outpatient setting. I saw a few cases during the GP practice placement, mostly young people, though I ended up referring them to a drug-dependency unit.”

Chris raised an eyebrow. “Why the interest? Be wary of choosing something you may not have had much hands-on experience with. You've only one more placement after this and it's not been firmed up yet—it may not be in a DDU setting.”

“Drug abuse is so bound up with social issues. I want to study ways to give outpatients extra support, stop them from falling back into old patterns. And rave culture is everywhere. This feels like the zeitgeist. I've done some reading—we don't yet know the long-term effects of all these stimulants on young people's brains, and generally there is no pharmacological alternative.” I shrugged. “It feels like territory for psychologists rather than the psychiatrists and their prescription pads.”

Chris smiled. “A psychologist rescue fantasy?”

I shrugged. “Dunno. No, actually, a need to get in somewhere where I think psychologists may be the ones to make a real difference.”

“Remember, we can't—”

I interrupted. “Yes, I know. We can't help everyone. Not unless they want to be helped.”

Chris smiled. “That's right.”

“The thing is, Chris, that I think that many do want to be helped, but they have too much stacked against them and also don't know how to accept help. Being cared for is alien to some people.”

Chris smiled to herself, into her coffee. “Their choice.”

“Don't agree. Most hard-core drug users I've met have been born into poverty and violence. They don't ask to learn to self-medicate. It's the shit they have to grow up with and live with, and it's the one thing we can't help them with.”

I took a breath; that came out a little stronger than I'd intended.

Chris sighed and looked up at me. “Be careful—if you see any of the people you treat as victims, then they
will
be.”

“Sometimes they are!”

The sharpness of my tone caused others around us in the small coffee shop to look around. Slightly embarrassed, I picked up my empty coffee cup and concentrated on draining its last drops.

“So let's talk about this placement and the goals.” Chris paused and took a slurp of her coffee. “This young woman. What's her story?”

“Bombastic ‘pull yourself together' father and a reserved mother.”

“Reserved how?”

“Controlled. Protective of her daughter. I feel some passive aggression toward her husband.”

Chris drained her double espresso. “And the girl? Millie?”

“Mollie.”

“Sorry. Mollie.”

“Bright, tight and controlling. Talented and self-destructive. Wants to be a wisp.”

“Wisp?”

“Yeah, kind of there but not there. Smoke, not solid.”

Chris nodded.

“The thing is, Chris, this young woman frightens me. She's so intent on her own destruction. And so bloody bright. But she's almost deluded about her body, how underweight she is. I have never met anyone as controlled in my life.”

Chris wiped her mouth with a serviette. “What are you afraid of?”

I had to think about that. What was I afraid of?

“That her need and ability to be in control are greater than my ability to help her get better.”

“This powerful young woman reminds me of that little girl you saw in the adolescent unit on your second placement. What was her name?”

“Imogen.”

“Mollie is powerful like Imogen. This behavior serves a purpose. How's your systemic family therapy?”

Shit.

“I don't know. Three lectures and a workshop?”

“OK. Not enough. So here are the goals for your placement. Number one, get a first draft of your literature review and the beginning of the empirical paper to me by the end of next week.”