This is mental illness. It is vicious waves slamming you on to a rocky shore, and your tired body dragging itself up over and over, until you think you might as well lie down on the sharp edges and let the water subsume you. Then, unexpected strength helps you stand; there’s sun on your face and salt on your tongue. But the next wave comes – an unannounced, unkind fist – and knocks you forwards. You wipe grit from your eyes and swipe blood from your knees and cough mud from your lungs. In the distance there are smiling faces and raised hands: Why do you keep falling over?! Just stand up! It’s gorgeous over here!
This was me in the winter of 2015, towards the end of my first term at university, when I crumbled spectacularly and was bundled back home. “What went wrong? What was it you couldn’t cope with?” people asked. I wanted to say: I couldn’t cope with being me. I couldn’t cope with finding myself in a brand new setting and being unable to turn myself into a brand new person. I couldn’t cope with the hours I spent frantically, privately filling and emptying myself, or the blades I carried in my pencil case, or the search history crowded with questions about how many paracetamol tablets I would have to take to definitely die. I couldn’t cope with the drone in my head telling me: “You don’t deserve to be alive. You don’t deserve to be happy. You are a horrible, terrible person.”
I didn’t say that. I said there was a lot of pressure, and I struggled to keep up, and I felt homesick. And some people smiled and said, “Yes. You poor thing – but everyone feels like that when they leave home.” And other people rolled their eyes and wrinkled their noses and thought: God. What a fuss..
I was terrified by what was happening in my mind – but I had already given my brain a book of its own [The Time In Between: A Memoir of Hunger and Hope, written a year earlier], in which my insides had been scraped out and plastered on to the page. Now my eyes needed to be swivelled outwards. So I rolled up my sleeves and prepared to sink my hands into the dark innards of mental illness in the wider world. I wanted to climb into the grimiest corners of the unwell mind, and open the curtains. I wanted to invite outsiders to peek through the grubby windows and see “what it’s really like” I wanted to give voice to those whose internal demons rendered them dumb.
Over the following months, I contacted and met 70 young women – of all classes, colours and creeds – and heard stories of pain so visceral they knotted themselves around my own nerves. We met in pubs and coffee shops, bedrooms and university houses, kitchens and living rooms. During 100 hours of interviews, we talked about transformations from happy child to tortured teenager; about difficulties that had been waiting in the wings from birth, ready for a grand entrance; about settled, “normal” younger years disintegrating into disarray in adulthood. These women allowed me to slip through tiny gaps in their armour. The experience was harrowing, heartening and humbling. For the book, I created characters embodying each of the major difficulties my interviewees described.
Why young women? Put simply, women are more vulnerable than men to many common mental health conditions. The most recent Adult Psychiatric Morbidity Survey (APMS) in 2014 found that all types of common mental health problems, including depression and generalised anxiety disorder, were more prevalent in women than in men. And the discrepancy was most marked among young people: 26% of women aged 16–24 reported symptoms of a common mental health problem, compared to just 9.1% of men of the same age. Furthermore, a 2005 study carried out in the US suggested that 75% of mental health problems are established by the age of 24. Young women also report higher levels of self-harm and suicidal thoughts than any other group.
This is not to say that male mental health does not merit attention: in 2014 the Office for National Statistics reported 6,122 suicides in the UK, of which 75.6% were male. Given that suicide and suicide attempts are associated with a psychiatric disorder in 90% of cases, men are clearly suffering, too. Transgender people, or those with a complex gender identity, are also reportedly facing elevated levels of both psychological distress and stigma year on year.
But I chose to talk to young women because, in my experience, being a young woman is, at best, challenging and, at worst, agonising – and I wanted to know whether others of my age and gender who suffer from mental health problems do so in a similar way to me. Initially, I worried about whether their stories would be compelling enough. As readers, we look for stories that are wide and full and exciting – but mental illness is often small and empty and dull. By the time I had finished interviewing, my primary concern had morphed: my interviewees’ experiences were too vivid; too shocking; too dramatic. Would anyone believe that these things had really happened? I can only reiterate: it is all true. It is all real. These things happened. These things happen.
I have been awake for three minutes, and have had enough of today.
I have been awake for six minutes, and have had more than enough of today.
I will get up in one minute.
It really makes no sense to get up before 8.00 now.
I have left it too late. If I get up now, I will be rushed. When I swing my legs over the side of the bed, the tension will spread upwards, through the soles of my feet, into my calf muscles, around my pelvis, up to my chest. It will be like stepping into a bodysuit of tension, and I won’t have time to shower, and not showering will make me more tense, and I will scuttle around the room like a crab, ferreting clothes from the piles crouching in the corners. They will smell stale and will be too creased to wear without ironing.
There is no way I have enough time to get out the iron, let alone the ironing board.
I can’t iron this morning, so I have nothing to wear, so I can’t get up.
If I get up now, I will be really rushed. Maybe I still have a fresh shirt hanging in the wardrobe, and if I wore trousers the creases might not show as much as they would in a skirt…? But then I would have to brush my hair, and it’s been four days since I washed it now. What if I pulled it into a ponytail without brushing? Could that work? No, of course it couldn’t, don’t be absolutely fucking ridiculous, Abby.
I have to leave the house in eight minutes in order to arrive on time. I have to leave the house in 13 minutes in order to arrive late-but-not-so-late-it’s-an-issue-late, and in 18 minutes in order to arrive pretty-fucking-late-but-maybe-possibly-hopefully-only-late-enough-to-warrant-a-raised-eyebrow-and-not-a-“Can-I-have- a-word?”-late. But calculating that has taken two minutes.
I can’t breathe. I can’t fucking breathe. There is a corset laced up around me, crunching my ribs together like a rattle of xylophone keys, clenching my chest, clasping my throat, squeezing so fiercely that all the air inside me is forced out…
I can’t get there on time. I can’t be late. But I can’t get there on time. But I can’t be late. And I can’t… I can’t… I can’t I can’t I can’t I CAN’T I CAN’T I CAN’T I –
There are billions of burning, blistering beetles crawling up the back of my neck, over the top of my scalp. My skin is melting, sizzling and splitting under their feet.
Silence. Stillness. Soft and sad as a soggy cornflake, softening sadly in chalk-white milk dregs.
I can’t get to work on time now. Even if I rocket up, stuff unsocked feet into uncomfortable shoes and leave the house trailing an armful of clothes, ready to button myself into “competent professional” mode on the train, I won’t make it. I can’t be late. My manager has already had to “have words” about my lateness, and she left me fairly sure that if she has to have many more of them she will make sure the need for those words to be had is eliminated. If I am late, I will be eliminated.
I can’t be late, but I can’t go to work without being late, so the solution is clear: I can’t go to work at all. Simple. Why didn’t I think of this in the first place?
I am still lying, mummy-like, but the knots of panic trussing my insides begin to unravel. Like rainwater dripping from leaves, the tension gradually drip-drip-drips from my body. There is a dull ache across my shoulders and a throbbing ache at the back of my head and a gnawing ache between my ribs. I ache all over, as if I have just emerged from a boxing match with an opponent who has run rings around me.
I creep across the hallway, desperate to lock myself in the bathroom and scrub my skin raw. The trickle from the shower nozzle spills lazily over my too-big body. It is not quite hot enough to stop me shivering. Back in the bedroom, I sit heavily on the bed and the day stretches ahead of me like a deserted racetrack. An ocean of unfilled time, to float in. Surely there could be no greater luxury than a sea of blank time. Only my unfilled day doesn’t feel tantalising. It feels like a sentence. I can’t look at my phone because I don’t want to see the red dot above the voicemail icon and I don’t want to listen to the grey voice of my manager. She will not be able to mask her exasperation at having to ask why, yet again, I have not seen fit to grace the office with my presence. I can’t open the curtains because I think it’s sunny this morning. When it is sunny you should be warm and colourful and Shall we eat lunch outside today? You shouldn’t be indefinably sick.
I screw my wet towel into a ball and drop it by the bed. I fish a fat bottle of tablets from the silt of my bedside table and twist off the childproof cap. One pink sleeping pill of dubious provenance purchased from eBay will have no effect on me. Three will make me drowsy. Five will knock me out. Six will leave me with a hangover. I count the pills in my hand – 1-2-3-4-5-6-7 – and swallow them with flat Coke. Then I pull the duvet up, over my head, and the world goes black.
This waiting room is like a Halloween party attended solely by skeletons. These are hungry-eyed young women whose cheekbones protrude like cliffs from the plateaus of faces. Their arms and legs form a forest of spindly branches, knees and elbows bulging like knots. Their stomachs sink towards their spines, organs compressed by the wasted habitat, and yet still they bobble around, driven by nervous energy. Enormous heads balance on reed-like necks. Bodies bend like stalks. They look like daffodils.
Some of the daffodils drink from bottles of water they look too frail to lift, crossing and uncrossing their legs, bladders protesting at the influx of gallons and gallons of scale-weight; some pace the perimeter of the room, faces contorted with concentration – “650, 651, 652, 653… Can’t sit down, can’t be lazy, can’t be FAT…” Some massage swollen jaws, frantically trying to hide the evidence of last night’s purge. They are blond-haired, brown-haired, fair-skinned, dark-skinned skeletons, whose bones ripple proudly beneath sagging jeans and bagging jumpers. Bundles of crumbling, starving bones.
I sit in the corner of the waiting room, desperately trying to disappear. I am not a daffodil. I am a shrub. I feel obscenely, indecently fleshy. My breasts are so swollen the straps of my bra cut into my shoulders – and everyone else is lithely androgynous. My thighs spread across my seat like treacle. I fold my arms across my chest, and then across my stomach, and then across my shame, and pretend I am not the elephant in the room.
When the neat-looking psychiatrist appears at the door, six pairs of starving eyes flick up, empty and alert. He calls my name like a question, and I burn. Now they know who I am. I heft myself up and follow the psychiatrist up a flight of stairs and into a small, nondescript room. There is a desk at one end of the room, piles of papers stacked on its smooth wooden surface, and beside it stands a set of scales. I look at the scales, and my stomach twists in horror.
Oh God. Oh God oh God oh God oh God. I can’t be weighed. I can’t ever be weighed. I’ll break the machine. He’ll laugh at me. He’ll conduct an on-the-spot demonstration of my obesity, inviting three of his downstairs skeletons to stand on one another’s shoulders and wobble on to the scales, their combined weight still not matching mine…
“So, Elizabeth, you were referred here by…” He riffles papers officiously, reading a line or two and nodding. “Oh, I see. Yes, I see. You self-referred.” He says, “you self-referred” as if he were saying, “you stripped naked and flung yourself down outside the clinic, beating your fists on the ground until one of our poor, perplexed receptionists relented and gave you an appointment”.
“Yes. Well, I… I thought this might be… the place to come?”
“Of course. Quite. And you believe yourself to be suffering from… bulimia?”
“Well… it’s… it’s sort of like that… except kind of like… without the throwing up?” I squirm in my seat, the red in my cheeks deepening as familiar shame washes over me. What?? You don’t even throw up?? Call yourself sick?? I mean, we struggle to take those slacker bulimics seriously around here, but at least they put in some EFFORT! At least they TRY to do the right thing! Here you are, expecting help when you don’t even make yourself SICK!
It’s not for lack of trying, I want to say. I can’t count the number of times I’ve knelt on the bathroom floor, hunched over the toilet bowl, arm halfway down my throat, desperately trying to get something out. I do try – honestly, I do. But I think there must be something wrong with me – you know, like, anatomically? Because it just doesn’t work. I don’t like doing it, truth be told. It hurts my throat. I know. Pathetic. I know. Sorry.
“Ri-i-i-i-ght,” he says, drawing out the single syllable like elastic.
“So it’s more like… well, just the eating part. Without the sick.”
“Ah. So, we’re talking about some sort of binge-eating problem?”
“OK. And how many times would you say you’re bingeing at the moment? In an average week?”
I can’t say the real number. No way. Maybe I should… halve it? Quarter it?
“Probably… two days a week?”
A third. That’s a fair fraction. A solid third. Very slightly less than a solid third.
“And, on these days, you binge just the once?”
What do you mean? When I say two days, I mean two DAYS. The binges last all day. They are continuous. It is eating from when I wake up to when I go to sleep.
“Erm, yep. Once.”
“OK. Right. And, during these binges, what sort of foods do you tend to eat?”
Fuck fuck fuck fuck fuck. I can’t tell him. They feel so dirty, those foodwords. I CANNOT say them.
“Just kind of anything really. I guess.”
“Ri-i-i-i-i-ght. Do you use any compensatory behaviours? Any means of avoiding weight gain from your binges?”
I wish you’d just say it. I wish you’d just say: “Well, I’m looking at you sitting there fatly in that seat, and I can see you don’t do much to avoid weight gain, or if you do then the things you do clearly don’t work, so I’m fascinated to hear whether you are aware of this or whether you are labouring under the delusion that you are somehow taking steps to make yourself slightly less grotesque than you really are.”
“No. Not really. Not much.”
“Elizabeth, I wonder if you might be able to tell me what you were hoping our service could offer you?”
You didn’t need to say it like THAT. I KNOW I’m ridiculous. I KNOW I’m a fake. I KNOW I don’t belong here and I KNOW you don’t want to help. I’m fat, but I’m not stupid.
“I’m not sure, really. I looked on the website and I saw there’s a day programme here? Like, day treatment? With meals and therapy groups and stuff?”
“Ah, I see. Well. We normally reserve places on that programme for our most unwell patients. They’re very limited, you see. The places. So we do have to give priority to those who… whose eating disorders are most severe, in terms of their physical state, if you see what I mean.”
Just say it. Just say “thin”. Why dress it up like this? “We only take the very thinnest.” That’s what it comes down to, isn’t it?
“We also have a registered dietician who sees patients for meal-planning, nutrition education… That sort of thing. Of course, in our service she does primarily work with those who need to increase their weight: formulating high-calorie diets and such…”
I’ve been amazingly successful in formulating one of those for myself.
“…but I’m sure she also has experience of working with people who… well… I’m sure she wouldn’t be averse to formulating a weight-reduction plan, if that was…”
“Oh, right. I guess. I mean, thanks, that sounds like it could be helpful.” “Good. Excellent. Unfortunately, our service is quite oversubscribed at the moment – and we do have to give priority to those most in need of treatment.”
I wish you would send me away. I wish you would tell me, straightforwardly, that I’m not sick enough. Not sick at all. Just undisciplined. Greedy. Lazy. A horrible person. I really think I would choose that over this awful, humiliating pity.
“Yes. Of course. Thanks. It’s really kind of you.”
“Not at all. So, I imagine we would be looking at a wait time of around six months – possibly nine, but six if we’re lucky.”
I’ll email after the session and say I want to be taken off the waiting list. I won’t still be here in six months. I will have eaten myself to death.
“Oh. Cool. Thanks. It’s really good of you. I really appreciate it.”
Oh, well. At least you didn’t ask to weigh me.
“Not at all. I hope the big exams go well! Finals, eh? Such a privilege. Best years of my life. All downhill from there – make the most of it while you can, I say!”
There’s no more hill to go down. To get lower I would have to burrow into the ground. “Mmm. Yes. It’s great. So much fun. So lucky. Well, thanks for seeing me… I’ll just – ”
– go and continue the slow suicide.
“Oh, Elizabeth? One more thing – sorry, little bit awkward I know, but before you leave would you mind just hopping on the scales for me? Let me have a quick check of your weight?”
What I wish I could tell you about my anxiety.
You might be surprised by the range of things that make me anxious. It can include responding to text messages or emails, and sometimes even reading text messages or emails. I worry that every message I receive is going to be upsetting or hurtful, and that any message I send could be “wrong” in some way. If you find me difficult to contact, it may be because my anxiety is high. I am not deliberately ignoring you.
I know I often make plans then back out at the last minute. I always want to stick to the arrangement, but sometimes I panic and feel I can’t. I don’t cancel plans because I can’t be bothered to go through with them: I do it because I feel there is no other option.
Sometimes, when I need to get out of doing something, I tell lies. I feel ashamed that I lie so much, and I lie because I’m ashamed of the real reason why I am cancelling: because of my anxiety. It feels much more acceptable to pretend I am ill or having to deal with some family emergency than to let you know how intense the anxiety is.
I can’t just “stop worrying”. When my brain goes into an anxious spin, “mind over matter” doesn’t feel possible. I often worry about small, insignificant, almost nonexistent things. It is rarely helpful to tell me that there is “nothing to worry about”. When my anxiety is very high, it can make me feel insane. I feel helpless and paralysed. It is a horrible way to feel.
I am really grateful when you try to accommodate my anxiety in plans. This might be telling me about arrangements in great detail, making sure there are opportunities for me to leave if I need to, or asking if there is anything you can do to make things easier for me. I know it is a lot of effort but it makes a huge difference to me.
Please don’t tell me to breathe deeply. That won’t magic my anxiety away.
I am not being deliberately difficult or trying to make things hard for other people. A lot of my anxiety centres around what others think of me, so it is never my intention to cause inconvenience or exasperation.
I really appreciate it when you continue to spend time with me and invite me out, even when I repeatedly make excuses or cancel on you. Unconditional acceptance and loyalty is very rare but very special.
No matter how much I seem to isolate myself, I still want friends.
• In the UK, Samaritans can be contacted on 116 123 or email email@example.com. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international suicide helplines can be found at befrienders.org. If you are in the UK, you can contact the mental health charity Mind by phone on 0300 123 3393 or online
About the author
Nancy Tucker is 24 and currently reading experimental psychology at Oxford University. She sought out the interviewees for her book in internet support groups, schools, universities and among people she met while suffering from anorexia and bulimia in her teens. Her powerful memoir of those dark days, The Time In Between: A Memoir of Hunger and Hope, was published when she was just 21.
She says: “There’s a lot more mental illness at school and university than most people think. Students at uni in particular are struggling with being away from home for the first time and the pressure to be high-achieving.” Again and again Tucker heard from young women that university mental health services – not just those in the news, like Bristol, where suicides have soared – are underfunded and oversubscribed. “And the counselling on offer is extremely time-limited,” she adds. “Peer support is easier to access but a lot of the people needing help have big problems that cannot be dealt with by a 19-year-old with a few days’ training.” Universities are very keen on offering peer support services, Tucker says, “because it allows them to say they are providing more help than they actually are. It’s very cheeky.”
Young people are being failed outside the education system, too, with MPs warning this month that plans to transform NHS mental health services for the young will take too long to effect real change.
Tucker says her own mental health has improved significantly, but adds: “Even though I’ve written two books on the subject, I find it hard to talk about. It’s not that I expect a hostile reaction, but people who have no experience of mental illness find it very hard to empathise with the kinds of harrowing stories I uncovered researching this book. We need to make these stories more familiar.” Interview by Lisa O’Kelly
• That Was When People Started to Worry is published by Icon Books, £14.99. To order it for £12.74 go to guardianbookshop.com or call 0330 333 6846. Free UK pp over £10, online orders only. Phone orders min pp of £1.99