Dilemmas

While it may seem quite obvious to Andrew that his cousin is reaching Belsen-like proportions, he has to remember that when she looks in the mirror she probably sees herself as the Fat Lady in a fairground; he must bear her weird reality in mind, and tread on eggshells when he approaches her.

And approach her he must. If he tries the clod-hopperingly direct approach - "You're thin as a rake and you're starving yourself to death," he'll almost certainly meet with denial and rage. Actually he's almost certain to meet with denial and rage whatever he says, because anorexics are full of terror about facing up to the truth. They fear, wrongly, that they'll be carted off to hospital and force-fed like fois-gras geese.

Since anorexics can be devious and cunning - with themselves as well as everyone else - Andrew need not feel any pangs of conscience about being a little bit devious himself, if it's going to help.

He must enlist her parents' help, but probably by emphasising that he's worried stiff about her health, rather than making them feel guilty about her possible emotional problems. If he simply says to them that he thinks she might die of starvation, it'd be a weird parent who didn't respond.

He could also ring up her doctor behind her back, and see if he or she could inveigle her into the surgery for some spurious check-up.

Theories about why people become anorexic abound, but no one really knows what's behind it all. Sometimes it's a cry for help; sometimes a shout of rage. Sometimes it seems to be a fear of growing up, because without food puberty can be delayed; or in some cases it's a way of keeping control over a life that seems to be turning into chaos.

There may be a genetic factor at work. Or sometimes it's simply a desire to be Kate Moss gone berserk. The decision to eat as little as possible can be a hypnotic appetite switch far more difficult to turn back on than to turn off in the first place.

But the bottom line is that Andrew can't make his cousin realise something that she doesn't realise. He can only fertilise the ground by making it easier for his cousin to allow the realisation of her condition to grow. And he can do this not only by expressing his anxieties, but also by accepting her as a person, be she gross or gaunt, and by encouraging her to talk about herself and her problems.

Simply, he must be a good friend to her. That will be more helpful than any amount of anorexic literature left "casually" around the house, or huge mountains of spaghetti shoved under her nose.

Eating Disorders Association: 01603 621414.

readers' responses

Writing as a recovering anorexia sufferer, I know the problem of how to help is a very real one. Anorexia is a private illness and it takes an enormous amount of courage to admit that you have a problem with eating, weight, diet and exercise.

Comments such as "you're killing yourself" and "just eat normally" are definitely not what to say, in fact these can make the sufferer feel even more isolated and misunderstood. Anorexia sufferers have extremely low self-esteem - any comments made can be taken as severe criticism and can send them down further.

I think as far as confronting your cousin is concerned, you need to be as gentle, caring and approachable as possible. It may be best to let her know gently that you have noticed her excessive exercise and undereating and that you are worried about her as she is looking so unwell. But please be prepared for an angry response as she may resent, as I did, people interfering with her private world. You need to be there for her and accept her for who she is and show her there are lots of people who genuinely care what happens to her. She needs a lot of encouragement and positive comments about things she is good at. I wish you all the best.

Claire Vincent, Brighton

Andrew is right that it is very difficult to help an anorexic if they will not recognise they have a problem, but someone has to try. Anorexics rarely accept that they are ill and the longer they go without help, the harder it is for them to recover.

Andrew's description of his cousin shows that she is already quite seriously ill and needs professional help as soon as possible.

It is fantastic that he wants to help her but he should be wary of trying to do it alone. He would probably be much more successful if he helped her in a supportive role, leaving the central problems to experts - but finding the right expert is absolutely crucial and this is something that it is very difficult for anyone to do alone.

He should not be too quick to judge his cousin's family and her boyfriend. They may well be facing the same difficulty that he is - that they want to help but do not know how.

I write from experience, having had anorexia for the past six years - I'm nearly 20. When it was first noticed, I was given professional help, which was a disaster as the people I was sent to misunderstood me totally. One by one, I alienated the friends that tried to help me during this period completely. Anorexics are not easy people to live with. Today, I would say I am coping - but I am doing it very much on my own, which isn't easy. It is a taboo subject in my family; my sister won't admit that I ever had a problem.

I think it's wonderful that Andrew wants to help his cousin, especially as he seems to understand that anorexia is about more than wanting to be thin, but recovery from anorexia is a very long haul, and he should be aware of exactly what he is letting himself in for, because nothing could be worse for her than if he gave up half-way through.

Anon

Andrew will get advice by the ton, all of it garbage, including any that I may give. Advice is the curse of the twentieth century. The best counsellors should be seen and not heard. Andrew will do what he wants to do and all the advice in the world will not affect that. Andrew's cousin needs to understand how important she is, to herself, not to her parents, boyfriend, or cousin. To herself. In the end she will do what she wants to do anyway. And why shouldn't she?

If Andrew really wants to help, he should communicate with her, that is, listen. If she talks long enough she will listen to herself, if she is allowed to talk long enough she will understand that she cannot hope to please everyone. In any case the only one she is aiming to please is herself.

Andrew's last sentence says, "How can I help someone who has yet to recognise she has a problem?" She doesn't have a problem, Andrew. She is doing what she wants to do. Because she is not doing what you want her to, you consider her abnormal. You are the one with a problem. Do you recognise it? I write from bitter experience. It took me years to get over my problem.

Terry Colley, York

Dear Virginia,

My 14-year-old son says that soon he's going to get a ring put in his nose. When I object - I think it is a preposterous idea - he argues that it's up to him how he looks, it's not doing anyone any harm, and that I wouldn't like it if he objected to something I wore. Of course he is quite correct. I know he needs my consent before he can get it done, but I've no doubt he will find a way round it.

Added to this, my daughter of 12 wants to go out in the streets in mini- skirts that literally show her bottom. She says everyone wears clothes like this these days, but I'm so worried for her safety.

Am I just being an old fuddy-duddy? I really do want my kids to feel good and independent, and don't like saying no to them, but perhaps I'm being too liberal.

Have any other readers had this problem?

Yours sincerely,

Marina

All comments are welcome, and everyone who has a suggestion quoted will be sent a Dynagrip 50 ballpen from Paper:Mate.

Please send any relevant personal experiences or comments to me at the Features Department, The Independent, One Canada Square, Canary Wharf, London, E14 5DL; fax 0171-293 2162, by Monday morning.

And if you have any dilemmas of your own you would like to share, let me know.