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here is a transcript (with many of the 'and's removed so that it is easier to follow!
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Mark Porter (presenter):
At least 1.5 million people in the UK are thought to have some degree of eating disorder. Contrary to the stereotypical image, they are not all teenage girls and young women, although these do account for a large proportion of those with the most severe form: anorexia nervosa.
Despite being both common and serious, anorexia remains poorly understood and surrounded by myth and prejudice. It’s only natural, for instance, for desperate parents to worry that something they’ve done is partly to blame. But, is there any evidence to support this?
Robert Spooner lost his daughter Melanie (who was a doctor) in 2011, after a 17 year battle with anorexia which started in her early teens.
Robert Spooner:
For me, if you don’t put fuel into the car tank, the engine stops and I said those words to Mel with tears in my eyes. I came across ..what we learned to live with which was a complete wall: the face locked up, her face locked up, there was a battle ground for a long time to come.
Bryan Lask:
My name is Brian Lask, emeritus professor in Child and Adolescent Psychiatry at the University of London.
For so long, parents have been blamed for bringing on anorexia in their children. It’s just nothing like that simple. In fact there is no evidence whatsoever that parents can create anorexia nervosa, even in a genetically vulnerable child. That evidence has never been shown. We believe we have got a much better understanding now and the way we see it is that there is a particular structure in the brain which is called the insula. The insula is a bit like Clapham Junction. It’s a major part of the network, and, [of] the messages that go around the brain, many if not most travel through the insula.
So, if the insula’s not working properly (which is what we believe is the case in anorexia) then messages get distorted or misrouted or lost en route. It has a knock on effect around the brain and it means that many different structures in the brain are not working properly as a result.
To give you just a few examples of that, one structure that is not working properly is the frontal lobe (that’s the thinking, planning, deciding part of the brain). It means that thinking is much more difficult when you have anorexia because it’s swamped by feelings. The feelings come up from a different part of the brain (the feeling brain going up to the thinking brain). Thus people with anorexia are desperately anxious.
In addition, there’s another part of the brain called the basal ganglia which is responsible for drive, for perfectionism, for exercise, for compulsion, and that is over firing, it’s overactive, because the insula which would normally modulate it or regulate it is not doing so.
So we now have very high anxiety, we have obsessional drive; we have inability to think properly.
And then another part of the brain that’s not working because the insulin is not working properly is the part of the brain that deals with visual special images. That’s probably why people have such a distorted body image in anorexia, they see themselves as fat when actually they are extremely thin and all that we attribute to the failure of the insula.
One of the myths that still persists is this idea that people with anorexia choose to go on a diet, choose to remain the way they are, choose to have all these features and that’s just as nonsensical as saying someone with pneumonia chooses to have a fever, to be short of breath, to cough and to be in pain when they breathe! None of that’s a choice and none of what happens in anorexia is a choice, so trying to convince someone with anorexia that they are thin, not fat; that they should eat; all those things; it doesn’t work because it’s like trying to tell someone with pneumonia, ‘Don’t cough’ or ‘Don’t have a fever’. Their illness is a very manipulative and controlling illness but they are not manipulative or controlling.
Robert Spooner:
By the time she [Mel] was 18 and leaving school, my wife had worked quite a miracle with Mel. Mel looked absolutely fantastic. And then off she went to Cambridge where she was driven, and one of the things about these people is they’re perfectionists. She was..
(Mark Porter: Studying Medicine)
Robert Spooner:
Studying Medicine and..well, she didn’t believe in herself totally. She also felt pressured by the university itself. There was one of her supervisors who told her she wouldn’t pass, and that was the year that she came first. And that was a bit of a nail in a bit of a coffin for Mel because a driven person was even more driven. And part of the dealing with it was self-denial of food. This was where she could…there was a buzz from not eating and she was away from home.
Bryan Lask:
Most people with anorexia are perfectionists, and are therefore compulsively driven to achieve at a very high level, they work extra hard to do so and that shows through in school work. It also shows through in the illness because they are desperate to achieve the lowest possible weight and starve themselves as much as necessary to do so. When people starve, they deprive themselves of essential nutrients, one of which allows us to develop the neurotransmitter, noradrenalin. Noradrenalin we do need for all sorts of things but one of the things is makes us anxious. If we get too much, we get very anxious. So, if we starve ourselves, we lose the nutrients that give us noradrenalin, our noradrenalin levels drop and we feel less anxious. Now, people who have very high levels of anxiety find themselves less anxious when they’re not eating therefore that reinforces the pattern of not eating. Then nice, kind people like me come along and make these people eat and they get anxious again, and they don’t eat and they get into a cycle. It is one of the reasons why anorexia is so difficult to treat. It’s one of the very few illnesses where people don’t want the treatment because they actually feel better with the illness than without it.
Robert Spooner:
All along the way, she had problems getting help, and accepting help. Bear in mind she was an extremely clever person, and may even have been cleverer than those who were trying to treat her. So she had the answers to things that were said, like,
‘There’s a problem with your blood test, potassium level’s low’
‘No, it’s not! This is the range and this is the tolerance, and it’s within the range’
Mark Porter: well, why wouldn’t she accept the help? She was very bright, she was a doctor, and she must have known exactly what was going on.
Robert Spooner:
She knew absolutely what was going on, it wasn’t where she wanted to be. We spoke about what was ‘Mel’ and there was a person called ‘Anna’, the anorexia. Anna was so often so much more powerful in her mind and just wouldn’t let her eat and drove her with an addiction. So she wanted to be better, she wanted to have a normal life, she knew what the effects were on her body and she was already starting to have osteoporosis, but she just physically couldn’t make herself eat. It just wasn’t going to happen.
Bryan Lask:
We’ve talked about rewards and addiction and so on, and if you’ve got an addiction you may not be motivated to overcome it, you have got a problem that rewards you (every now and then) like gambling rewards you, until you keep going. So anorexia gives a certain degree of reward, then there’s no motivation to overcome it. One of the most important types of therapy is motivational therapy, where we work on the patient’s motivation, to help them to gradually reverse the balance. The balance is so much in favour of the illness, the pros of the illness, and we try to help them work towards the cons outweighing the pros rather than the pros outweighing the cons.
Mark Porter: [That was] Bryan Lask and you’ll find some useful links on anorexia on our website.
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Here are those links:
A good book by Bryan Lask.
And another