Dark disorder that preys on perfection

Madison Turner, with father Steve, started her long recovery from anorexia after being kept in a locked hospital room. Photo / Doug Sherring

At 11, Madison Turner began starving herself. It was the start of a 3-year battle with anorexia that saw her weight plummet. Now Madison is a healthy teenager with dreams of acting in London. She talks to Abby Gillies.

Nothing in 18-year-old Madison Turner's bubbly personality hints at the personal hell she and her family have been through. Four years ago, in the grip of anorexia, she had starved herself to 26kg. Doctors told her family to prepare for her to die.

Maddie remembers a normal childhood growing up in Whenuapai. She was a cheeky daddy's girl who grew into a high achiever. She loved drama and strived for the best.

She dreamed of feeling sexy and slim. Like most kids, she had a little puppy fat, but no more than others her age.

Parents Steve Turner and Lily Reynolds separated when Maddie was 5. Six years later, she started worrying about her weight. She was 46kg.

Quickly, anorexia became a voice inside her head, a physical being and an addiction she wanted to please and couldn't ignore.

"It was almost like I wanted to be the best anorexic I could be. I didn't want any other anorexic to beat me and, once I'd got into that role, it was hard to come back from it," she says.

At first, she stopped having lunch, then dinner. Within a month, Maddie was eating nothing. By the time her family realised something was wrong, Maddie's weight had dropped to 37kg in two months.

A doctor diagnosed her as anorexic and she was admitted to a clinic in Auckland for treatment.

She was given daily meal plans and worked with a therapist and doctor.

"I was pissed off with myself that I'd gone back to eating."

Within a month, she had weaned herself off food again.

Maddie had always been a good eater and the family ate normal meals growing up. Turner, 48, became aware that some of the boys at school were teasing his daughter, then 11, by calling her fat, "even though she wasn't fat".

Several weeks later, he realised she had lost a huge amount of weight. "She would look for reasons not to eat and she'd want to go to the mall a lot and I realised it was about walking to get more exercise in."

As anorexia took over, Maddie stopped smiling and became an angry "demon" as she descended into isolation, focused only on losing weight.

"It didn't matter how much she lost, she just talked about not wanting to be this fat person that she never was," Turner says.

Food became something that terrified Maddie and every day became a battle with her father, who tried to force her to eat.

"He had to hold me down to put a smoothie down my throat while I was kicking and screaming," says Maddie. "I used to say I hated him and that he was poisoning me."

Maddie's weight dropped to 32kg following her 12th birthday and she was admitted to Starship hospital.

Turner had only one focus - to get his daughter well. He and his partner broke up and he gave up most of his shifts to spend up to 16 hours a day with Maddie, trying to get her to eat.

During one feed, she became so violent, four people were needed to hold her down while she spat, bit and punched. "It was draining."

In 2006, Maddie became a day patient for a few months, which meant taking her to hospital three times a day from her Torbay home to be fed.

"One time we were at the beach and it came to lunchtime and she just started screaming. I had to physically carry her screaming to the car and everyone around us thought I was kidnapping her."

Maddie's mother tried to help, but their daughter would push her away.

"It [anorexia] made all of these promises to me and I believed it - she was giving me these promises that eventually I'd be happy," Maddie says, referring to the disorder as if it was a person she once knew.

Several times a day, she would bend over and run her fingers down her spine to check how many vertebrae she could feel, a habit she still finds hard to break. At night, she did 100 star jumps at a time in her hospital room and jogged on the spot to burn off extra calories.

Her starving body changed in other ways, too. Her hair became thin, her nails brittle, shoulders permanently hunched and her eyes popped out of a sunken face.

She was always cold, "but I liked that because I read somewhere that if you are cold you burn more calories".

In 2006, aged 13, Maddie had spent two years in and out of hospital battling her eating disorder.

One hellish day, her father and a nurse held Maddie down for eight hours to stop her exercising after a feed.

"He had to sit on me and hugged me and told me how much he loved me and I just screamed at him."

The only way to get her to eat was through a tube in her nose, but she found ways to stop that, too.

As soon the nurses' backs were turned, she would sneak into the bathroom, pull the feeding tube out of her nose and clench her stomach muscles, forcing the food out.

With the forced feeding, Maddie gained a few kilos and was able to return to Northcross Intermediate School.

But within a few months her weight had dropped to 28kg and she was readmitted to Starship.

There was worse to come.

At 14, Maddie reached her lowest weight, 26kg.

"When I got into the 20s, that was the most exciting time of my anorexia," she says. "I thought I could get into the teens."

At a loss on how to stop her exercising or rejecting food, hospital staff locked Maddie into a room with only a mattress and watched her 24 hours a day.

The strain of caring for his daughter caused Turner to become anxious and he was prescribed antidepressants.

When Maddie became a "caged animal" in the locked room, he started to contemplate the possibility that his daughter might not make it.

Doctors told the family to prepare for her death. "I thought about her dying. I would say, 'don't take her, take me. I've lived enough of my life."'

In a desperate attempt to save her life, Maddie's non-religious parents turned to God for help and decided to have her baptised.

With nowhere to hide and no way to exercise, Maddie felt they had won. "All the dreams I had were gone."

After 2 1/2 weeks in the locked room, Maddie realised there was no other way out and decided to eat.

She focused on her love of acting and craved "being a woman and having curves and boobs and being attractive to men".

"I caught a glimpse of what my life could be like and I didn't want to let that go."

Crying and shaking, she forced down a high-calorie drink. It was another 3 1/2 years before she started to escape anorexia's grip.

From drinks, she progressed to meals, but every mealtime was a struggle.

Eventually, she was able to leave hospital and was accepted into the Corelli School of the Arts.

By 15, she weighed 50kg, and today Maddie is a healthy 59kg.

It is the disorder no one talks about, it affects largely the middle and upper classes and is killing more Kiwis than any other mental illness.

Those affected are reluctant to talk about it because of the stigma of mental illness, says Clive Plucknett, chief executive of Challenge Trust, which runs Auckland eating disorders service Thrive.

"It is a rich person's disease and the stigma that goes with that. If you're rich, you have a much greater motivation to cover it up."

Eating disorders have the highest death rate of all mental illnesses. One in 100 treated anorexics die each year, according to the Eating Disorders Association of New Zealand.

About 68,000 New Zealanders will develop an eating disorder in their life.

Of those, 60 per cent will fully recover within six years, 20 per cent will partially recover and 20 per cent will never recover.

Last year, Challenge Trust launched Thrive in Auckland, the first dedicated eating disorders service in New Zealand.

Before this, parents went to Australia, Sweden and other parts of the world to access dedicated eating disorders services for their children and spent on average $1000 a day for treatment, travel and accommodation.

With treatment times ranging from six months to three years, families often had to use savings, sell items and mortgage homes to fund treatment.

Thrive offers residential and day programmes for patients, aged 15 and older, with eating disorders.

But patients are referred to the centre only when they are deemed too unwell to be treated anywhere else.

Each week, Plucknett receives calls from around New Zealand and the world from parents desperate to get help for their children.

"They're at their wits' end."

People who develop anorexia tended to have some common personality traits, says clinical psychologist Karin Ruppeldt.

"They can be quite perfectionist. It's pretty common for them to be from a middle-class family and also to have trauma in their background or mothers who are not emotionally attuned," she says.

They are unhappy with the way they look and have a distorted body image.

The clinic's staff are trained to be alert to all the tricks - secretly exercising, "water-loading" before weigh-ins to boost their weight, hiding food in their pockets, under their plate or dropping it into the roll-up cuffs of their trousers.

"The main point is about control. You can control what you eat but you can't control life - it represents self-esteem," says recovery support worker Ashley Bellingham.

And underlying the illness is the feeling that they are not good enough, says psychiatrist Dr Darryl-Lee Prince - "they have to be perfect".

One girl who joined the centre was surviving on one apple a day. Others were restricting their food intake to two mushrooms a day.

Today's afternoon snack is an apple, a glass of water and three sultana biscuits, which patients have 20 minutes to eat.

If they don't, they are given a protein shake and, if they don't have that, they are tube-fed through their nose.

Staff must also stop patients from underdressing to make their body work harder to stay warm, running on the spot at night and finding excuses to go up and down the stairs to burn extra calories.

Bathrooms are only opened on request because the toilets were repeatedly blocked with vomit.

One bedroom we pass upstairs is decorated with a pink-spotted bedspread and hearts on the wall, a reminder of the age of some of the girls here.

As the girls file past me after a nutrition session, I watch their eyes drop immediately to my body, betraying the focus of their attention.

They look impossibly thin, their eyes huge in their faces.

"The earlier you catch this, the more chance of success, but the system is not geared for that," says Plucknett. "You've got to be sick before you're treated."

He'd like to see more education around eating disorders, as the causes and motivation are complex.

"They [parents] think 'just bloody eat. What's wrong with you'?"

Anorexics often don't make it to old age because ongoing starvation can lead to osteoporosis and fatal damage to the brain and organs.

Plucknett's goal is to pool the best resources, ideas and treatment from overseas to provide a world-class service in New Zealand.

"This is an insidious disease. It's far bigger than anyone realises, far bigger than I realise."

For Maddie, anorexia is in her past. "I feel the happiest I've been in my life. I'm comfortable in my skin and I don't really worry about my weight any more."

She is flatting in Grey Lynn, working for a fabric wholesaler and plans to move to London to act.

She and her father have rebuilt their relationship and the experience has brought them closer.

She wants other young people to know the reality of anorexia - a life she will never return to.

"I can't see what the attraction to being in hell was.

"As much as life may seem horrible or not what you want, it will always be a hundred times better than developing an eating disorder.The darkness that I've experienced, no one in the world has to go through."

Turner agrees, saying watching his daughter battle the illness was the worst experience of his life - one he wouldn't wish on any parent.

He and Maddie always had a close relationship, but during the years she was sick, the girl he knew was replaced with an angry stranger.

The scars of those years have stayed with Turner. Tears aren't far away when he talks about them and he struggles to let go of Maddie, worrying about her constantly.

"To this day, I still hang on to the fact that she's vulnerable and needs my support."

With his new partner, he is trying to move on with his life.

"The other day she rang me and said 'Dad, can I meet you at lunchtime? I've got no money and I need some lunch'. I thought 'shit, bloody oath', so I dropped everything and and bought her some lunch."