Dr Nadine Leese

In this post I want to offer some thoughts of living with, and recovering from, an eating disorder while doing a PhD. I’ll start with the disclaimer: eating disorders come in so many different forms and I can only speak from my experience of anorexia, but I have tried to focus here on points that I hope may be of use to those with other eating disorders, and perhaps also other mental health problems more widely. In my experience, doing a PhD while suffering from an eating disorder was an incredibly isolating experience: although I knew people suffering from eating disorders, and people with whom I could share the struggles of the PhDs, it felt as though there was no one who understood the complex difficulties that result when those two worlds collide. So I write this if only to say, you’re not the only one, and that it’s possible to come out the other side.

While I felt alone in my illness, the statistics tell a different story: a recent campaign by BEAT, the national Eating Disorders Association, looked at the problem of eating disorders within universities. The report focuses on undergraduate students, but many of the issues raised remain true for postgraduate students – in fact I suspect that for many sufferers, entering further into the world of academia acts as a catalyst for these problems to worsen. This was certainly the case for me: having had an eating disorder for many years prior to the PhD, it was this period that exacerbated the illness to its worst. Difficulties that will be familiar to all PhD students – isolation of PhD study, imposter syndrome, anxiety and perfectionism, to name but a few – created a vicious circle in which my eating disorder could steadily worsen. Days spent studying alone at home fostered the social isolation that anorexia thrives upon, allowing eating disordered thoughts and behaviour patterns to become increasingly entrenched. The anxiety of imposter syndrome was further fuel for the eating disorder to thrive: considering myself not good enough to be in academia I further believed that my ability to do a PhD depended upon my anorexia, which gave me the drive to work hard enough to succeed in the competitive world of academia. I told myself that I couldn’t possibly be good enough to get the PhD on my own, I was nothing without anorexia; so how could I possibly stop, when succeeding in my PhD felt so entirely dependent upon my illness?

It seems straightforward enough now to recognise that this was not the case, and that being ill was a hindrance not a help, making it ever harder to produce the work required of me. Many eating disorder sufferers are reluctant to admit that the negative effects of the illness inhibit daily life; looking back, I’m not sure how I managed to get to the library most days, let alone write a PhD. Physical symptoms included fainting, dizziness, extreme cold, headaches, stomach ache, muscle pain, bruising, tiredness and joint pain; psychological effects caused by the impact of starvation on the brain meant difficulty sleeping, being unable to think about anything other than food, poor concentration span, and particular difficulty with abstract or conceptual thought. There are also a host of associated mental health problems that often accompany an eating disorder, such as depression and self-harm. Finally there are the implications of extreme anxiety in social situations involving food and drink – i.e., the vast majority of academic events; at my worst, I have dropped out of conferences at a day’s notice because the fear of eating in an unknown situation became so great.

It was half way through my PhD when I hit breaking point, and finally sought help for my eating disorder. I was very lucky to be living in the right area, and referred to an excellent specialist eating disorders centre; for many people those services simply are not available. The reality of recovery was much more complicated than I can detail here, but suffice to say that therapy made me worse before I got better, and that as a result I had to face telling my supervisors about my eating disorder for the first time.

There is so much stigma around mental health, and it is so little discussed in academia, that it is difficult to know what will be the consequences of breaking the silence. In the case of eating disorders, there are additional worries caused by misconceptions of the illness in the media; anorexia is often perceived as an extreme diet, not a serious mental health problem, and I worried my disorder would seem vain and superficial in the context of academia. I also thought that my illness seemed so obviously self-inflicted that it was wasting others’ time to ask for support. Admitting to having an eating disorder in a professional context was a very uncomfortable move, and I had little idea of how to approach the conversation with my supervisors.

There were a few steps I took which eased the process, and these may be helpful for others broaching similar conversations about mental health. I emailed in advance asking for a meeting – outside of normal supervision time – to discuss some personal difficulties. I kept the email brief but flagged up that there was something particular to discuss, so that there was some prior context when I walked into the room. I wrote down some key pointers that I needed to mention in advance, including:

• The exact diagnosis I had been given and what this meant.
• The programme of treatment I had been put onto, and the expected duration of aspects of the programme (this was unpredictable, but it helped to have a sense of perspective of what would likely be happening over the next few weeks and months, and to know when I could schedule meetings around appointments).
• The ways in which the eating disorder effected my academic work; I was brief, but covered some of the points above to give my supervisors an idea of why work was becoming increasingly difficult.

During the meeting, I tried to keep things factual and to these points. Together, we came up with a plan of action and I was clear of what the outcomes of the meeting were.

The response of my supervisors was everything I could have hoped for: they showed compassion for my wellbeing, were forthcoming about how they could support me academically, and were informative on the administrative aspects of illness during the PhD. Above all, they treated my mental health problem with the same seriousness, respect and lack of judgement as if it had been a purely physical illness. I was offered 6 months temporary withdrawal from the PhD programme while I went through recovery. My supervisors and department were very encouraging about my taking this leave so that I could come back to the PhD well and refreshed from a break. In my case, I decided that it was not in my best interests to take time out while going through recovery; I wouldn’t say this is the right decision for everyone and it’s important that students should feel supported to make what they feel is the best decision for their recovery. There were various reasons why I didn’t take the leave offered, but most important was that I wanted to be able to recover in a way that I knew would be sustainable in the context of academic life. Staying enrolled on my PhD while in recovery meant that I was putting in place recovery strategies that I knew would work alongside the pressures of my everyday workload, and enabled me to find ways in which the unhealthy cycle, whereby work and anorexia exacerbated each other, could be broken.

I finished therapy around the time that I submitted my PhD, although neither ending is that simple to define, and both the process of recovery and the time after the PhD submission have presented new uncertainties and challenges. Now fully recovered, perhaps the biggest challenge of all is to keep hold of the importance of mental wellbeing within a work culture that feels so set against that. I have said often that one of the hardest things about recovering from an eating disorder is realising just how disordered society is when it comes to food and weight: being recovered is to find yourself in the unexpected situation of having a healthier relationship with food and weight than the majority of people around you, and constantly having to fight against the pressures of a disordered culture. In a similar vein, I’d say that the hardest thing about recovering from mental illness in academia is realising the extent to which the entire system is deeply disordered in its attitudes towards mental health: asserting one’s right to mental wellbeing sometimes feels like the most rebellious and revolutionary of acts one can perform as an academic. For my part, I refuse to let work drive me to ill health again; I’ve seen how fragile health is, and taken too many chances to know that nothing is worth that risk. But it took getting extremely sick for me to be able to reach this point, and it is a daily challenge to maintain that belief; academia needs a culture change where we start to view mental wellbeing as a right, not a luxury.