A History of Psychiatry in 5 Objects

  1. 400-500 BC: Humorism

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Figure 1: Humorism

Humorism was an early theory for the mechanisms of the body. Hippocrates (400-500BC) stated that illness was caused by an imbalance of four humours; blood, phlegm, yellow bile, and black bile (Stelmack and Stalikas 1991, 257), an idea that reigned until the 17th Century (Bos 2009, 29). Galen (Hague 1991) later linked blood to a sanguine disposition (hopeful); yellow bile to a choleric one (easily angered), phlegm to a phlegmatic one (calm, neutral); and black bile to melancholia (sadness). It was understood that imbalances could be adjusted with physical treatments, such as bloodletting and emetics that would remove a humour that was in excess (Androutsos et al 2008, 32), and bleeding and vomiting were evidence that the imbalance was rectified.

Humorism provided a holistic view of wellness that acknowledged the importance of both physical and environmental factors, such as diet and exercise (Telles-Correia and Marques 2015). It was predominately a departure from supernatural ideology and the role of the gods, in favour of the concept that physical and mental health were intrinsically linked (Bos 2009, 31). Bos (2009, 29) believes the decline is linked to a parting from a focus on character in favour of alternative theories. Nevertheless, the idea of balance remains prevalent.

2. From the 17th C: The Asylum

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Figure 2: Bethlehem Hospital 1714

The concept of locking up the insane began in the late 17th Century (Porter 2002, 51-52). The Asylum was an institution based on moral therapy; the premise that psychology and compassion could be used to treat severe mental illness (Rosenblatt 1984). Prior to this, individuals were largely kept in the community (Porter 2002). One of the earliest hospitals was Tuke’s York Retreat (1796) (Rosenblatt 1984, 246), which echoed the theory of Pinel breaking patient chains (Porter 2002, 58). Both advocated for routines, pleasant surrounds and to abolish restraint.

The asylums were self-contained yet isolated, with architecture that was part of the treatment (Porter 2002, 62). Early on, conditions varied greatly and following outrage at abuse of patients like William Norris at the Bethlehem Hospital (1814), a move was made towards regulation through the Mad House Act of 1828 (Wiles 2016). However, due to overpopulation, patient care declined and by the 1890s more were leaving dead than cured, influencing consequent deinstitutionalisation (Wiles 2016, Porter 2002, 64).

Originating as a place of refuge, asylums were a sign and place of progress (Porter 2002, 65). While it is argued that moving the focus from the body to the mind merely meant switching repression type (Foucault, 1988, 266), this does not warrant overlooking the introduction of compassion, hope and a person-central approach (Shorter, 1997, 4).

3. 1939: Electro-Convulsive Therapy

2Figure 3: Australian ECT Machine (Melbourne Museum 2017)

Electro-convulsive therapy (ECT) is arguably the greatest discovery of psychiatry, and the most effective and empirical treatment (Shorter and Healy 2007, 2).

Replacing chemical alternatives such as metrazol and insulin, both dangerous and less successful, it is a form of shock therapy (1935; Shorter and Healy 2007, 6) which was based on Meduna’s idea that schizophrenia was an antagonist of epilepsy. The concept was to treat symptoms by disrupting brain activity through seizures, coma or loss of consciousness (Piotrowski and Guerra 2016). The development of the Bini-Cerletti ECT machine was motivated by the desire to find a safer treatment.

4. 1951: The First Antipsychotic (Chlorpromazine)

Laborit’s and Rhone-Poulence’s discovery of Chlorpromazine (1951), the first antipsychotic, was a precursor to the rapid development of the psychopharmacology industry (Ban 2007).

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It was initially used with general anaesthesia to sedate and prevent shock(Carpenter and Davis 2012, 1168) and when trialled on patient Jacques Lh. undergoing ECT, an improvement of psychiatric symptoms was observed (Ban 2007). This was replicated by Deniker and Delay, who announced in Luxemburg that Chlorpromazine reduced psychosis symptoms(Carpenter and Davis 2012). Following this, Chlorpromazine saw the wards of asylums grow calm as noisy schizophrenic patients became quieter and more docile (Elkes and Elkes, 1954, 560), thus reducing violence and the number of hospitalised patients. Hence, despite some side effects like tardive dyskinesia, it became regarded as a miracle drug (Ban 2007, Carpenter and Davis 2012)

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Following moral therapy’s failure, antipsychotics offered the possibility of a scientific and medical approach that shifted the location of clinical care(Carpenter and Davis 2012, 1168). It wasn’t long before advertisements began marketing Chlorpromazine at not only schizophrenia, but also emotional instability, hiccups and cancer (APA 1956, 2; APA 1958), highlighting the lack of understanding of the mechanisms of the drug. Over time the uses became more specific and psychopharmacology grew rapidly and chlorpromazine prompted the development of the dopamine hypothesis (Carpenter and Davis 2012, 1170).

5. 980- The Diagnostic and Statistical Manual of Mental Disorders-III

5Figure 6: DSM-III

The third edition (1980) of the APA’s DSM (Diagnostic and Statistical Manual of Mental Disorders), was revolutionary for the diagnosis and treatment of mental illness (Decker 2013, xvii).

The DSM-III influenced psychiatry’s shift from an aetiological and psychoanalytic focus, towards descriptive classification (Decker 2003, xvi). Neo-Kraepelinian in nature, (Tsou 2016), it emphasised symptoms and course and aimed to provide clear and valid definitions (APA 2017). This was influenced by the 5-axis system implemented by Spitzer, who advocated for biological ideas (Decker 2013, 315-317). The manual was larger than it’s predecessors and involved the caveats that the criteria were not completely discrete, and should only be used by psychiatrists (APA 1980), for whom it became convenient shorthand.

The DSM-IIIs flaws can be seen through attempts of subsequent editions to rectify mistakes, such as homosexuality’s removal in 1973 (Cooper 2004, 6) and some argue that it has not managed to progress beyond description (Tsou 2016). The criteria were not as clear or evidence based as intended, and symptom thresholds excluded many people from diagnosis (Cooper 2004, 5-22). Nevertheless, the DSM-III was a milestone document due to its descriptive diagnostic categories and the support for which it gave to the disease model (Decker 2013). It was the first DSM to become widely used by professionals and provide a uniform method of diagnosis (Tsou 2016).

The results of electrically induced seizures in a patient called Enrico X, were presented at the 3rd International Neurological Congress (1939), with a reported significant reduction of symptoms (Shorter and Healey 2007, 43), from which ECT rose to popularity in the 1940s. Early on, seizures would result in physical harm and this led to the development of muscle relaxants and use of anaesthetics (Piotrowski and Guerra 2016).

Despite initial popularity, in the 1980s antipsychiatry and politics resulted in rapid decline in the use and reputation of ECT, damage that is still being reversed today (Shorter and Healey 2007, 145). ECT’s development is significant as it is an empirical treatment that can produce rapid responses to acute symptoms of psychosis and depression (Shorter 1997, 3).

 

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But you don’t look depressed

I don’t know what image the word ‘depression’ conjures in people’s minds but I can guarantee it’s not the smiling and chirpy university student. The reality is, no one can read minds, and it’s impossible to know what’s going on for someone unless you ask them.

I’ve been told by health professionals, that I don’t look depressed or that I’m doing better than what I’m saying I am. But unfortunately, they’re judgements are usually based on what is visible and not what isn’t. not usually the case. I may look happy and be smiling but really, inside I am struggling with feelings of despair and worthlessness. Struggling with the feeling that I don’t deserve to live. Sometimes this facade may be on purpose but that’s not always the case.

Regardless, I want you to know when I’m struggling. Whether I try to hide it or not, I want you to know because in that comes a sense of validation. The knowledge that while this may be in my head, it is still real. What I’m feeling is real even if it is not obvious.

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The new antidepressant hypothesis

Being a science student and having studied antidepressants, I thought I knew how they worked or at least why people thought so but after a lecture on the history of their development, now I’m not so sure.

Originally, in the 1950s-60s the thesis was that too many Monoaxamine Oxidase neurotransmitters (MAOs) such as serotonin and norepinephrine, were being oxidised by the brain. This led to a deficiency of them and thus depression. Drugs were developed to maximise the amount of MAOs in the brain, by preventing them from being oxidised. The idea is that high levels= better communication= stronger mood regulating circuit. The results were good! They appeared to work, yet serious side effects were often seen.

In order to reduce side effects, a new hypothesis was developed. The serotonin hypothesis. The idea was too much serotonin was being taken up by presynaptic neurons in the brain leading to a deficiency and ultimately depression. People, therefore, speculated that altering the level of serotonin would alleviate the symptoms of depression. This is where SSRIs were developed. They act by stopping the reuptake of serotonin and increasing the levels of it in the brain. Again, they appear to work. SNRIs do the same thing but for serotonin and norepinephrine.

The basis of these theories was PURELY SPECULATIVE. No one has been able to prove them. Though it could be argued that new research does exactly that, but this would depend on who you talk to.

Irving Kirsch showed that for people who’ve been on SSRIs before and experienced the side effects, if they’re then given a placebo drug with the same side effects, it appears to work. In his study, there was no significant difference between an active placebo (with side effects) and SSRIs. Yet, many people have criticised his work.

Studies have suggested that; changing serotonin levels in a healthy individual doesn’t cause depression, attacking symptoms of depression with SSRIs is no better than with an active placebo, and the placebo effect is critical in treating depression. Furthermore, one popular antidepressant bupropion appears to reduce depression in some people but it has not impact on serotonin at all, but dopamine and norepinephrine.

Obviously, though, I couldn’t just accept all of this to be true because I have seen antidepressants work, hell I’ve even FELT them work at times. In my day to day life I have yet to come across a pill that makes me feel ‘not depressed’ but I know that when I’m at my worst, medication is the only thing that can pull me out of it. So I turned to doctor google.

Apparently, there is this other theory that antidepressants cause neurogenesis (birth of new brain cells). This could explain why ADs take a while to work in the brain (whereas if it were just the amount of neurotransmitters you would expect them to work right away) because they are altering the pathways in the brain. I was drawn to how lots of these studies list physiological and psychological stress as a causal factor because it reflects the idea of early mad doctors, that neuroses were caused by stress. However,  it’s not a foolproof theory because some AD studies show neurogenesis and some don’t + it could be unrelated to what ADs actually do. Yet, it’s still really interesting.

I refuse to believe that antidepressants don’t work, but maybe they don’t work the way we think they do. Or maybe they do and we just happened to stumble upon the MAO idea by accident without having a clear reason for why this is the case.

What is your personal opinion and/or experience on antidepressants?

 

 

The day my cat saved my life

In more ways than one, she’s been my lifeline through the last few years. But there’s one day in particular that she saved me.

A little over a year ago, my mum came home from work late one night to find our cat meowing outside my door. It’s not normal for my mum to check on me when she gets home as it’s usually quite late but on this particular night, my cat’s behaviour concerned her. She opened my door and found me unconscious after a suicide attempt. If she hadn’t checked on me that night I may not have made it through. My cat saved me and allowed me to get treatment before my body starting failing.

A few nights ago, I had an incident with self-harm. I heard a noise at my door; my cat was outside meowing and wouldn’t stop until I let her in. She then proceeded to make herself comfortable on my bed and curled up against my chest all night long. The physical contact with an animal is often used as a therapeutic technique and remembering her beating chest and purs against my skin, I can imagine why. There’s something reassuring knowing that you are not alone in the world.

Now, this might seem normal to a lot of you but my cat knows that I am a restless sleeper and prefers to sit on the end of my bed. So the fact that she chose that night to curl up with me makes me think that she knew I was having a hard time and that I needed her. Her intuition was spot on.

I’m so grateful for her. She is my rock. My companion. My saviour.

No eating disorder movie is helpful

I got 20 minutes into watching Netflix’s new movie  ‘To the Bone’ and turned it off (and here’s why you shouldn’t watch it either*).

I don’t need a movie to tell me what it’s like having an eating disorder, because I’ve been there done that. To anyone out there who has suffered or is suffering, potentially triggering yourself isn’t worth it. You don’t need to have every symptom portrayed in a movie in order to be a ‘good anorexic’, because the only way to be a good anorexic is to be dead.

Maybe the movie is in fact a good portrayal, unlike many already out there that can act us ‘how to’ guides to young people, or not (I wouldn’t know. I haven’t watched it). But that’s not really the point.

The point is, I don’t think I will get any benefit out of this movie and I don’t think that anyone else who has experienced an ed will either. And more than that, I’m sick of eating disorders. They are BORING. You hear the same thing over and over. One day someone is fine or maybe it’s gradual but then suddenly ‘boom’ and there’s the ed. The lucky people recover the first time. Some never do and most of us spend years in bouts of recovery and relapse. There’s nothing interesting about starving yourself or ending up in hospital.

I’ve had my share of supervised toilet and shower use and I’m not a fan. I didn’t enjoy being forced to eat and swallow when I didn’t want to, and sometimes wasn’t allowed the luxury of tasting my food. Where’s the joy in that? I’m sick of being weighed and pricked by needles. Of never feeling beautiful no matter what any number says. I’m sick of never feeling ‘enough’.

It’s true that the worst day in recovery is better than the best day in a relapse. I’ don’t know about you, but I’d much rather be choosing what I eat because I enjoy it and not because I have to have it. I like that I can spend my days doing things; waking up when I want, going on adventures and spending time socialising and having a life. I like that my cat sleeps on my bed and I look forward to preparing breakfast each morning.

I hope that soon I won’t have to associate with the word recovery because the eating disorder just won’t be in my life.

Don’t watch the movie. You don’t need it to tell you how difficult things have been or how strong and brave you are being for fighting. You don’t need to hear that because you’ve lived it.

A movie won’t tell you that you are beautiful and amazing and so worthy of life and love, but I am. You are wonderful because you are alive, with a beating heart inside your warm chest and not a character in a movie that only exists inside a screen.

You are you and that’s more than enough.

For more information about eating disorder please refer to the National Eating Disorders Website or visit the Butterfly Foundation.  You can also check out Headspace or contact the national eating disorders hotline on 1800 33 4673.


* this is especially important if you are or have suffered from an eating disorder in the past, or if you happen to be a teenage girl between the ages of 11 and 18 (adolescent girls are most at risk of developing an ed).

The inner battle of taking my medication

These pills, these tiny little pills. Especially this one. this single white pill.

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It seems so simple, so easy. Follow the instructions on the packet. Yet, my experience with it is so far from easy. Me and this pill, we have a complicated relationship.
This white tablet in my hand, you see, is an antidepressant. And it’s not just any antidepressant, it’s my antidepressant. Prescribed by my doctor because she believes it helps me, but I have so much trouble taking it.

I can’t tell if it helps me or not and taking it is difficult because it means I’m actively doing something to help myself. A lot of the time I don’t feel like I deserve help and I don’t know if I want to get better. Why? Because this is safe and familiar and anything different is scary. I don’t know how to live without mental illness. Feeling better terrifies me because who will I be if I am not who I am now?

For some reason, I can take sleeping pills and vitamins but antidepressants scare me. It’s because they affect your brain chemistry and your brain chemistry is makes you who you are. I am still the same person if I take this or not though and I need to keep reminding myself that. Taking this does not mean I am weak or will magically be cured. All it means is that I am taking it. Maybe it will help or maybe it won’t but regardless, I am still me.

I wish it was easier to do this. I wish my brain could see it as a solution or medicine but it’s hard to see it that way when results aren’t immediate and when it’s your brain that’s sick.I’m scared of feeling better but I’m also scared I’m going to feel like this forever.

I am starting these again because I have to, deep down I know I have to. I need medication and that’s okay. I wish there was a sign pointing to the one that is the right one; the solution of all solutions. But I’m learning that it’s not that simple.

Please work little pill, I need you to work, even if sometimes I don’t want you to.

You’re not beyond help

I know what it’s like to feel like the world would be better off without you. To have gone through medication after medication, sit through unproductive therapy sessions and to experience life through hospital walls. To feel like nobody can help you. I know how much it hurts to see how your suffering is affecting other people. I get it. I do I’ve sat and cried and begged for everything to stop because the pain was so unbearable that death felt like the only way out. But I’m here to tell you that there is no such thing as being beyond help.

You may feel like you are not worthy or that you’re too much trouble, but none of that is true. You’re not too much trouble and there are people out there who care and want to help. It’s okay if you haven’t achieved everything you want to. There’s still time. There’s still time.

The worst day with you here is better than the best day without you. I get that this may not feel true. I understand it might be hard to believe, but you make the world a better place just by existing. You are worthy of life and worthy of help. No matter how hopeless the future seems, you are worth the fight. Please don’t give up because you are worth it.

You are not beyond help. I haven’t given up on you and you shouldn’t either. Hold on. Please, please, please keep holding on. One day this pain will all be worth it. You are not alone in your suffering.

You are not alone.

Choosing Real Recovery

I’m sick of being sick. I’m sick of admissions and appointments and not being able to do what I love. I’m sick of putting hunger and a half-assed life over my own happiness. Of having to enrol and unenroll from university each semester because I’m too ill. I’m sick of denying myself foods that I love so that I can keep my weight at the bare minimum of healthy. None of this is healthy. I didn’t choose anorexia, but now I’m choosing to get rid of it.

It’s not that easy, I know, but I’m determined to beat this. I know it’s not going to be an easy journey and I don’t expect it to go smoothly, but I do believe in recovery. I know it’s possible because I’ve seen it happen for other people.

I’m finally accepting what it means to recover. For me, that’s eating enough food to satisfy myself and my dietician and increasing the variety of my diet. It’s choosing things for taste and not because the bitch in my head says so. It’s facing the thoughts again and again and not giving in. Recovery is going out and eating meals with my friends. It’s going to bed thinking about relapsing but waking up and sticking to my meal plan anyway. It’s gaining weight even though I’m scared of what that will mean, engaging in therapy and taking my medication.

The reality is, I cannot be healthy whilst I am undernourished. And I cannot be happy unless I am healthy.

I want to work and study and be independent. I want to have friends and joy in my life again. And to do that I need to recover.

You don’t have to feel ready to recover because chances are if you wait for the perfect time it will never come. You don’t have to feel ready, you just have to be brave.

Today I am choosing recovery, and not that fake eating disorder turned vegan or clean eating recovery you see on Instagram. I’m choosing chocolate and ice cream and happiness. Today I’m choosing myself.

I was hospitalised for Anorexia Nervosa Part 2; Inpatient life

(This is a 2 part series and if you haven’t read part 1, you can click here to read it first – Part 1; The lead up)

7 weeks. That’s how long the eating disorder ward was my home, by far the longest admission I’ve ever had. I ate, slept and lived within those walls with no more than 7 other patients at any time. Those girls (and guys) became my friends and my family, along with the lovely nursing staff.

The day I was admitted, I thought they had made a mistake. I wasn’t sick enough and I didn’t need to be there. I didn’t ‘deserve’ the label of anorexic or the privilege of a hospital bed because there were so many people out there who needed it more. But the thing is, that’s how eating disorders work; they convince you that you don’t deserve help when in actual fact everyone does regardless of the severity of their illness.

 

I sat on my bed and cried. And cried. And cried. I was escorted to the dining room to sit with the other patients. Then began the routine of eating, resting, more eating and still more resting. I began on level 1 of a refeeding meal plan and eventually worked my way up to a meal plan of three meals and three snacks a day. A meal plan that meets my bodies nutritional needs. In the beginning, it was extremely difficult. I spent many a mealtime battling my thoughts and wanting to refuse the meal or supplement. And sometimes I did. But the nurses were determined and week after week it got easier.

My day began at 6.30am each morning when I’d take my first lot of medication, and on Mondays and Thursdays I’d change into a gown and be blind weighed. Breakfast was at 8 am, morning tea at 10, lunch at 12 pm, afternoon tea at 3 pm, dinner at 6 pm and supper was 8.30 pm. For 15 minutes after snacks and 30mins after main meals (also the length of time we had to eat) we weren’t able to move around and had to sit in a living area. Afterwards, we had a little more freedom and could use the toilet (next to the nurses station) or go into one a small ‘quiet’ room, but really we were fairly sedentary. Throughout the day we had regular blood tests and our physical obs taken (anywhere from once a day to hourly depending on our health).

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Between 9.30 am and 9 pm at night, our rooms were locked. This was so that it was possible for us to be supervised with fewer staff, to help keep a regular sleeping schedule and to prevent overexercising. It was really hard not being allowed to sleep during the day or to spend time by myself and that’s one of the things I found the most difficult. I’m not a very social person so having to spend all day every day with other patients was a nightmare for me. Or at least it was in the beginning.

As this particular ward was underfunded, there weren’t many activities on. Twice a week, we hard art therapy run by a student and often only a couple of people would attend. I was usually one of them. I made a lot of collages in this time, as well as; watercolour paintings, paper mache type sculptures and journal pages.

Occasionally, though they were supposed to run weekly, we would have a group with the registrar that could involve anything from pros and con lists of our eating disorders to discussing identity or watching a video on the physical effects. We also had a pharmacy group with topics such as bone density, anxiety and sleep hygiene. Out of all of these, the best day of the week by far was pet therapy day. This was when we all got to sit around and cuddle a dog. Because what therapy is better than animals?

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art therapy helped me cope

Ward rounds happened twice a week and they were the bane of our existence. The night before we would fill out a form with questions relating to what we had achieved, what we were struggling with and what we wanted out of the program including any questions we had. The longer you were in hospital and the more you progressed in treatment, the more responsibility and privileges you would get. Common requests included; downstairs leave, leave from the ward, unsupervised bathroom visits, participation in ward activities such as cooking and take away challenges (a rotation of Thai, Indian and Italian) and the most requested of all; discharge.

During ward round we would go into a room with a whole range of professionals that usually consisted of about 10 people (psychologist, psychiatrist, registrar, doctor, dietician, pharmacist, social worker, nurse, medical students, unit manager and whoever else happened to be there that day) and it is one of the most daunting things I’ve ever had to do. Think of it as a job interview but with everyone prying into your personal life. Not ideal.

The nurses made my experience what it was and are the reason that I progressed as far as I did, farther than anyone had expected. They prepared our breakfasts (toast or cereal), snacks and lunch (sandwiches) every day, but not dinners which were provided by the hospital kitchen. They ate with us, provided meal supervision and encouragement, washed our dishes (low and behold there was no dishwasher on the ed ward) and became our supports. A lot of laughter was had over the dinner table, a lot of tears too but mainly laughter. I become close to a few of the nurses and will always be grateful for them and how they made me feel like a person again.

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One of the night nurses would leave messages for us to wake up to

I’m also grateful for the other patients and the special bonds we formed. Spending weeks and weeks with strangers, it was hard for us not to become close. Some of the girls I met were the kindest and most compassionate humans that I’ve ever come across and they are the reason I got through the admission in one piece. Having that support made mealtimes easier and gave me the motivation to eat so that I didn’t trigger anyone else or make eating more difficult for them. Though over time, it became less about that and more about getting better.

Though I went into this admission involuntarily, I am leaving with hope and desire for a better future. I take with me the knowledge that it is possible to beat this illness and that I possess the strength within me to do so. For the first time in a long time, I truly want to recover. I want my life back. I want to be free. It’s not going to be an easy road but I am finally ready to fight.


Part 1; The lead up

I was hospitalised for Anorexia Nervosa Part 1; The lead up

I never thought that it would happen, but here I am having just been released from an eating disorder ward. The last three months have been a blur that I would rather forget, but I am sharing my story in the hopes that it may help someone.

My eating disorder has been a part of my life for all my teenage years and now has made its way into my adult life. The two main risk factors for developing an eating disorder, though we know they definitely aren’t necessary, are being a girl and in the early teens. Combine this with being a perfectionist and having a chaotic home life, I never really stood a chance.

 

My weight fluctuated greatly throughout my teens and I crossed the line between OSFED, anorexia and bulimia nervosa many times. Most of the time I was still able to ‘manage’ it on my own, or at least I thought I could. It wasn’t until I finished high school and turned 18 that things got drastically worse.

I struggled through my first year of university and in the beginning of my second year my weight dropped drastically, to the point where I was physically and mentally at risk. Looking back, I should have been hospitalised at this point, but I stubbornly pushed myself through the semester with twice weekly physical checks and weekly bloods. I was falling down, unable to concentrate, my hair was falling out and I looked awful but I couldn’t acknowledge it. Eventually, as a result of my depression, my eating took on different extremes and I gained a lot of weight back as a result of a severe and lengthy binge and purge cycle.

A year later, in about March of this year things took a turn for the worse again and while in a psychiatric ward; I stopped eating and drinking altogether. Being in this particular ward was traumatic for me for many reasons and I believe was the reason for the severity of this relapse. I still have nightmares about it to this day. My weight once again reached the low it had been the year before and soon the dehydration lead to ECG and blood abnormalities. This is when I was made involuntary, had an NG tube inserted and was transferred to a medical ward.

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The week I spent in a medical ward was awful. I was bedridden, had a special nurse watching me at all times, 24/7 nasogastric feeds, daily ECGs, constant bags of fluids and electrolytes and supervision that included toilet visits and showers. The ward was a locked medical ward that meant I could not leave and I was kept awake by the machines beeping and the 5 other patients (many who had dementia) in the same room as me.

During this time I gained a fair bit of weight back and at a rate that was traumatic. My body was changing too quickly and yet I still wasn’t eating. At the same time, my outpatient team were hurriedly trying to get me a public eating disorder bed, a hard feat in Australia as there are scarce few available.

In the meantime, I spent two weeks in a youth psychiatric unit where the non-eating-disorder trained nurses tried to manage my declining mental health and eating. I was given meal support, but usually for only one meal a day (lunch) and by the occupational therapist who had experience in eating disorders. She was my saviour during this time. After two weeks I was discharged and put on a community treatment order so that when an ed bed came up I would have to take it. This was necessary at the time because I was still refusing help.

Barely a week later, and a month after I had the tube in, I gained access to an eating disorder bed in a public hospital which is where I’ve spent the last 7 weeks of my life.


Part 2: Inpatient life