was 16 when she first started to slip into the lonely, nightmare
She won a competition with school friends over who could
the most weight.
And it was from this ominous beginning that the
stone teenager became trapped in a cycle of binging, vomiting and
Over the months and years her weight dropped
that by the time she was 20 Holden weighed just five-and-a-half
doctors feared she was so frail she would die.
So they sectioned
and admitted her to North Manchester General Hospital.
marked a turning point in Holden’s life, when the staff of Ward G3
support Holden in overcoming her eating disorder.
describes it as when “her period of hell” began.
She was heavily
sedated, fitted with a nasal drip and confined to one
Psychiatrists then initiated a ‘behavioural therapy’
based on the principle that if anorexic patients are ‘rewarded’ after
gaining weight they would be more willing to eat
remembers with horror: “Fifteen nurses entered my room. Without
to me they removed every possession I had, including Get Well cards,
clothes, and cigarettes.
“They just marched off with everything.
doctor then came in and asked me what I wanted. I said I wanted to be
of the room and with my mum.”
Allowed just a nightie to wear
told that as her weight increased she would be granted ‘privileges’,
including use of a telephone and television, clothes, baths, make-up,
visitors and access to the ward’s toilet.
She was prohibited from
leaving the room she came to call her “glass cage”, and was denied
or writing materials until weight was gained.
“I remember one day
screaming and begging my dad who came to visit not to leave me,”
Holden who objected to being force fed and saw the treatment as a
system of deprivation and punishment.
“I kept pulling out the drip
because sedatives were being put through it into my stomach. Yards
yards of the plastic tubing used to come out. I was so heavily
could open my mouth but could not speak. I was a vegetable.”
doctors assured confused Holden the treatment was for her own good,
warned that if she continued to rip out the drip another would be
into a vein in her neck.
Holden saw this treatment which went on
five weeks as psychological torture.
And as the liquid food
into Holden’s stomach her weight ballooned by three stone.
was raped because the whole shape of my body was changed so crudely
without my permission,” says Holden.
Holden was treated in 1983.
force-feeding and isolating anorexics while employing behavioural
techniques is still practised today.
“It is often the under
busy hospitals which tend to use this stricter form of behavioural
therapy,” says Dr Jill Welbourn, who headed a Bristol eating disorder
for 25 years.
“It may be used in the kind of hospital where there
perhaps just three nurses for 26 patients. Although strict
therapy is less popular now it can depend on the luck of the draw as
where you live. There are whole areas in the country which are total
deserts in term of more contemporary less confrontational approaches
Holden believes the humiliation she suffered damaged
much it compounded her anorexia and distress.
Even now she fears
“I was put in that hospital room not for five
but for 10 years. I think it was unnecessarily cruel,” asserts Holden
her terraced home in Middleton, Manchester.
“You can not expect
to go through something like that and for it to have no effect. If it
about saving my life then surely I should feel happy about it.”
only in 1993 after becoming pregnant that Holden found the inner
to beat her eating problems.
Against medical advice she came off
her medication as she believed it would damage the baby she was
“I knew that I had to get well for my daughter. I had a
responsibility towards another life and could not afford to be ill.
Whereas previously I would vomit after eating, I learnt to force
swallow the food which I had vomited up in to my mouth.”
Holden had returned to a healthy weight of nine stone, she sought
redress for her “glass cage torment”.
Holden was encouraged when
granted legal aid to pursue a case of medical negligence against
Manchester Health Authority.
As part of the preliminaries,
medical notes were sent to the distinguished Dr Arthur Crisp, author
Anorexia Nervosa - Let me be.
He supported Holden’s version of
writing that her therapy “contained an unacceptable punitive element
may have led to specific abuse on some occasions... Ms Holden’s
is more likely than not to have caused her damage.”
In addition a
psychotherapist concluded the humiliation Holden experienced in the
of the hospital should be understood “as though it were a
But despite such condemnations, Holden learnt
this year that she would probably lose a medical negligence
legal counsel concluded the authority would be able to demonstrate
some ease” that other doctors would endorse Holden’s treatment.
believed the authority would be able to trace doctors who at the time
followed similar regimes on anorexia patients.
In effect this
put into doubt whether anorexic patients have legal come back against
experiencing trauma as a result of compulsory treatment.
of mental health user group The UK Advocacy Network says: “I think
represents a sad indictment of the mental health service. Research
anorexia has never looked at how compulsory treatment effects
“Compulsory treatment often leads to further problems.
be very humiliating and stigmatising for a patient and can take many
to work out how such treatment has damaged you.”
While Dr Welbourn
agrees that many anorexia patients feel aggrieved after compulsory
treatment, she believes desperate measures are necessary to save
She says she has known more anorexia patients starve to
than to complain afterwards.
“Compare it with someone who suffers
cardiac arrest,” she argues.
“A doctor might shove their hand into
person’s chest and squeeze the heart to get it going because the
is about to die. Now that could be an assault.”
lives and some of my patients have been grateful for being saved. But
others compulsory treatment has become their recurring nightmare. One
not know at the beginning how it is going to go.”
Dr Ross Connan
eating disorder unit at The Bethlem Royal and Maudsley Hospital
most professionals recognise the distress caused by compulsory
She says the pros and cons of such practice have to be
up before going ahead with it.
“You can spend the whole day
with a patient on what they should eat. But there comes a point when
patient needs to be fed.” she concedes.
“And often feeding works
when external control is enforced. Many severely ill patients find
the choice to feed themselves very frightening.”
acknowledges gloomily: “Patients have and will continue to feel they
“No body likes to be treated against their
and inevitably it will leave people feeling trapped and
Meanwhile Holden, now 37 and with no outward sign of
anorexia years, believes her turbulent family relationships lay at
root of her eating problems and that doctors failed to talk these
through with her.
“Is there really a doctor out there who would
up in court and support the hideous treatment I went through. Doctors
without a proper understanding of anorexia should learn that they can
A North Manchester General Hospital psychiatrist who
Holden’s case chose not to comment.