The truth about life on a locked eating disorder ward

Holding my mouth to the one-inch window gap, I took a desperate breath in, swallowing the fumes from the outside vents that amounted to all the “fresh air” I would be getting that day. A banging came from behind the door of the bathroom, then a voice: “I don’t hear the water running. You’ve got three minutes left!” I inhaled again, turned around, and let the drips from the shower head wash away any tears, before the healthcare assistant knocked again to tell me time was up. I wrapped a towel around me, asked her to let me out, and stepped back onto the inpatient ward, my timekeeper locking the door behind me. 

A few days earlier I had closed the door to my own flat, trading it for a temporary life under lock and key in an eating disorder unit; where doors don’t have handles, bathrooms are a privilege, and – though you may walk in freely – you must jump through hoops to walk back out. 

I had arrived, ostensibly, by my own free will, after receiving an email at work from my psychiatrist – addressed not to me, but to my GP and parents. Admittedly, it wasn’t a surprise. Having been treated as an outpatient for an encroaching eating disorder, I’d been losing weight and verve in tandem, but I had never lost my autonomy. Until now, that is, when I was being spoken about, not to. 

“Charlotte herself cannot make an informed decision,” she wrote, explaining that – divesting herself of my care – she had requested an urgent admission at my nearest NHS inpatient ward. It is true that I was sick, 29 years old and fighting a losing battle against a mental illness that had left me severely underweight and ridden with anxieties that festered for almost a decade, sparked by anxiety and OCD. It’s also true that, until that point, I had resisted inpatient treatment, deterred by a mix of fear, fatalism, and, in fact, a former 10-day stay at a facility, during which time my neuroses had multiplied. But once that email was sent, I was, officially, a passenger, cc’d into my own life story. And, with full encouragement from work, friends and family, I surrendered. 

Twenty-four hours later, on a scorching July day, my mum and I arrived at the hospital grounds in north London. We were buzzed through three separate doors and beckoned in by the charge nurse, who led us down a corridor, passing rooms with their doors wide open to expose women curled up in balls on their bed in a liminal state between sleeping and awake, a smell of staleness in the air. 

The single bed in my room had a thin foam mattress I could squish between my fingers. The door had a window, ensuring surveillance. A plastic, half-length mirror – which, crucially, couldn’t be shattered – offered up a bizarre, distorted reflection. And screaming cries could be heard from next door, which made me shiver in the heat. 

Two healthcare assistants arrived to search my belongings, confiscating nail scissors, tweezers, a razor, even a Smints dispenser, as if I were a prisoner reporting for incarceration. I was given a “welcome pack” with “guidelines for community living”. Visiting hours were restricted, room checks were at random, bathroom use had to be requested, and a detailed dress code forbade long-sleeve tops, hoods, pockets, hats and bags at the dining table, presupposing any attempts to secrete food. But it was one particular caveat that left a bad taste in my mouth: “Doctors and nurses retain the right to section a voluntary patient under the Mental Health Act.” 

To be clear, I do not wish to denigrate inpatient treatment, nor the NHS, which ultimately saved my life. Indeed, five years on since my admission I am a passionate advocate for medical intervention for eating disorders. However, there is a crucial difference between lack of resources, and lack of empathy and awareness from the bureaucracy at large, and it’s the latter which proved to be the most trying during my eight weeks inside. 

On the surface, the ward was run like a tight ship. Days were punctuated with six mealtimes (breakfast, snack, lunch, snack, dinner, night snack), six supervisions (45 minutes of being observed after every meal) and four medication times. There were two supervised fresh air breaks, restricted to five minutes each, plus – on paper – an assortment of group therapies. 

Below the surface, however, it was choppy waters. “You don’t yet qualify for outdoor time,” one particularly austere nurse told me on my first full day in treatment. “But I’m voluntary,” I said. “You can’t stop me from getting fresh air.” “Yes, we can section you,” came her reply – a response I became well accustomed to, though it always stayed just that: a threat. It was to be another two weeks before I was permitted to join the others for a grand total of 600 seconds of outdoor air per day. Not because I didn’t adhere to the rules, nor because I didn’t consistently put on weight, but because the physiotherapist didn’t show up to assess me until then. “She’ll come tomorrow,” was the perennial promise. 

Finally, three weeks after admission, and having hit several weight targets, I was allowed more leave – but only with parental supervision during the visiting hours of 4pm to 5pm and 7pm to 8.30pm. Luckily, my parents and sister lived nearby, and all three visited daily to reprieve me from life under lockdown (a word which I was more than familiar with a year before Covid). We would sit in the park or in the local coffee shop for an hour, and try to act as if everything was normal – for their sake, as much as mine. Their visits were bittersweet; I craved their company and a break from confinement, but every time they left, freely walking out that door that forbade my exit, I felt gut-punched and breathless. 

“It was like visiting you in prison,” my mum recently reflected. “But we also knew there was no other choice.” She mentioned again the screaming cries from the room next door, which I learned came from an 18-year-old woman being tube-fed, and often forcibly restrained. Nurses would nonchalantly take my blood pressure and sugar levels over her piercing howls, and, I’m sorry to say, I too became numb to the noise. It was the only way to bear it. 

Mealtimes, supervisions, and visits were punctuated by the odd meeting with a doctor, which felt like a work appraisal. Funnily enough, that was the only time I ever wore shoes – wishing to be taken seriously; not treated as an invalid. 

The 15 other women on the ward ranged in age from 18 to 50, and were mostly sectioned. As a result, a lot of them didn’t believe they needed to be there and, in fact, felt like they were being punished. They often ended up lashing out in a bid to evade treatment. 

I did make some friends – those, like me, who’d made the conscious choice to gain weight and, more importantly, regain a full life – but, overall, the atmosphere was tense.

Patients would comment on other people’s plates or meal plans, and even tell tales on one another’s behaviours, expending more energy on other people’s recovery than their own, and eclipsing any toxic experiences I’d ever had at my all-girls’ school. I’ve stayed in contact with one or two really lovely individuals, but – for my own recovery, which I’ll never take for granted – I only ever speak to people who have left their eating disorders behind. 

As for the staff, they were often too harried to help us, instead enforcing order by rules that seemed to forever change, and swapping consistency for coercion. Take the evolving meal plans, which were supposed to be amended by a dietician as our health improved, but which were almost never effectively communicated from caregiver to kitchen staff – sending inevitable patient anxiety around meals skyrocketing. Perhaps surprisingly, I was regularly distressed to learn I was being given less food and drink than required as the dietician, who seldom came to the ward, had failed to up my quantities (those on a lower weight must reintroduce food slowly to avoid refeeding syndrome; medical complications that arise as a result of aggressive nutritional rehabilitation). As my primary purpose was to gain weight and get better, it made my time in the ward feel frustratingly wasted. 

Meanwhile, the UK was in the midst of a heatwave, and yet our food and drink intake was so regimented we had to beg for a drink that wasn’t accounted for at mealtimes. When that was denied, we would wait – parched and flustered – until it was medication time, gulping down the thimble of water we were given to wash down our tablets. Any attempts to raise concern or complain at the lack of continuity were met with warnings that, if we persisted, we would be sectioned. 

Perhaps the biggest “laugh or you’ll cry” detail came down to condiments. Every meal, we were allowed to take ketchup, mustard and vinegar sachets, but the amounts differed depending on who was serving them. At lunch, you might be offered two ketchups and a vinegar, only to be told at dinner, by the new authority, that you were allowed just one ketchup and one mustard. On the outside, such things don’t bear considering; but inside, where everything is measured, scrutinised – and you yourself are reduced to a weight written on a piece of paper – a lack of clerical continuity is maddening. They are always right, which means you are wrong. 

Life on the ward swung between traumatic to strangely funny, like the nurse known for her sloppy attempts at drawing blood. Whenever she was on duty, there would be a collective sigh, before we would each return from daily blood tests with pin cushion-like arms covered in cotton wool. Or, the tactless comments often made by some staff members: “I wouldn’t eat that!” one supervisor said when asked if she would be joining us for dinner. Another, during one of my weigh-ins, looked incredulously at the increased number, which had jumped significantly in three days, before chuckling, “Surely that can’t be right.” Luckily, by then, I was determined to get better at all costs – but I can’t bear to imagine how those words might have derailed someone who was already wracked with fear over weight gain. 

Group therapies were cancelled at the last minute, and – when we did meet therapists – we mostly spent our time processing the challenges of living as an inpatient, with rules that changed at random. As Joseph Heller said in Catch-22, “Just because you’re paranoid doesn’t mean they aren’t after you.”

Ultimately, I believe I got better because I had chosen to do so before even going in, and used resources that were available on the ward – meals, and medical observations, including blood tests and heart monitors – while steeling myself against its therapeutic limitations. The problem is, with almost all patients under section, and those who are voluntary being constantly threatened with that prospect, it’s hard for many to keep focus on what in fact they’re fighting. It’s no surprise that many disempowered patients resist treatment – believing meals to be the stick, not the carrot – and fight the system, not the disease. Frustratingly, this is more common than long-lasting recovery, with many earning the moniker “carousel patients” for their repeated admissions. They’re monitored in the community, hospitalised when their health dips, stabilise, leave again – but with no meaningful therapy, the cycle continues. 

I’ll never regret my time inside, as it ultimately led to the one thing I value most: my recovery. Nor will I criticise the NHS for what is, starkly, a lack of government investment. There were exceptions – some members of staff who understood that we were people, not disorders. But the overriding lack of empathy, the punitive atmosphere and the dehumanisation of people in crisis are things I’ll simply never forget.