Marcadores no invasivos Marcadores serológicos.

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OVERVIEW

Kevin was interviewed twice, on both occasions over the phone. The recording of his first interview, due to a number of audio issues, was unable to be transcribed properly to provide full context to his answers. Kevin was asked if was would be willing to redo the interview which he was. In the debriefing period after the first interview he made some comments which he thought may be helpful and asked for them to be on the record. He was informed that anything from within the debriefing period could not be used, but if he wished for additional information to be considered he would need to send this in an email. Kevin duly did this and his comments from this email are referenced in this analysis, as well as from his second interview transcript.

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BACKGROUND

At the time of his interviews Kevin was approaching his mid-thirties. He classified himself as bi-sexual, but had not had a romantic relationship since 2010. He reported a history of disordered eating behaviours and self-harm at various points in his life, spanning close to two decades in time. His current bout of ED behaviours had started after his last

relationship had ended. Kevin by profession was a civil servant with middle/senior level managerial responsibilities and had taken unpaid leave in order to get treatment. At the time of the interview he was in discussions with his employer about being allowed to take sick leave as his treatment was taking longer than expected. Kevin was not asked about his treatment experiences as he was still undergoing treatment.

8.2.1 -FAMILY

Kevin identified his background as white middle class. He had a brother, but it was not ascertained who was the eldest and youngest. Kevin’s parents were still together. He said of his family relationships growing up; “I had a stable, relatively happy early childhood. My parents are both still together; I had a reasonable relationship with them and with my brother.” (Kevin Lines 124-26). Kevin’s use of the word “reasonable” was interesting and provocative when describing his relationship with his parents. When later in the interview

he spoke of role models he said of his father; “I have always felt closer to him and had a much better relationship with him than I have my mother.” (Kevin Lines 213-14). Kevin added that there was no history of mental illness in his family, but he also said that he would not be surprised if his father had suffered from undiagnosed depression. He also felt that there were no weight concerns within his family. However, the first exposure to EDs was in his first relationship aged around 16; his girlfriend had suffered from anorexia before their relationship began. It may be a coincidence that his own ED behaviours began at this time in his life. It must also be introduced at this juncture that Kevin spoke of his weight, pre his most recent ED episode, to be around 100kgs which equated to a BMI in the higher echelons of the overweight category.

8.2.2 -EDUCATION

Kevin is well qualified, holding a post-graduate degree and having experience on graduate training schemes. Unlike many of the men interviewed who had university experience, Kevin was positive about this saying; “it was one of the happier times of my life when I was at university” (Kevin Lines 246-47). It would appear at university Kevin experienced somewhat of a sexual awakening, as he “came out”(Kevin Line 159) as bisexual, and he also became active within the university’s LGBT society, actively studying feminist theory and history. At this point Kevin was openly questioning his masculinity (discussed in Section 8.6). Taking a step back from his university experiences, Kevin thought his

experiences of school could have been an influencing factor in his low opinions of himself. He said “I was bullied at school and that, I think, can have impacted, it was a stimulus to behaviour when I was a teenager” (Kevin Lines 128-30).

8.2.3 -BULLYING: A POSSIBLE SOURCE FOR KEVIN’S PROBLEMS

The cause of Kevin’s bullying was not shared and any reasons would be speculation. However, Kevin admitted to not enjoying contact sports. His future life indicates that he may have been a high achiever and he also described his personal self-image as “fat and weak” (Kevin Line 483). These factors could easily be reasons for him being bullied. However, the reasons for the bullying may not be important, as Kevin has developed defence strategies that have continued to protect him for much longer than his school days.

In order to deflect the bullying at school, Kevin employed a form of emotional repression; “it was one of the ways to avoid attracting attention at school when I was being bullied” (Kevin Lines 376-77). By not reacting to the bullying, he would stop the bullies getting enjoyment from his reactions, and therefore protect himself. He said “I deliberately cultivated this image of myself to be quite cold and quite cynical, that’s partly me and partly the mask that I put on to hide what was going on underneath.” (Kevin Lines 378- 80). However, the mask that he created to hide emotions at school appears to have become much more attached to him than he would wish in adult life, as he struggles to show his emotions.

8.2.4 -BULLIED, TEENAGE AND EMBARKING ON SELF-HARM

When Kevin shared that he had been bullied at school, he said he thought that it was a stimulus to his behaviour as a teenager. This behaviour he spoke of was cutting, and a number of his friends at that time shared the behaviour. Kevin said “we never really talked about it, but it was something there. If I was thinking back, it’s probably, I wouldn’t say it put the idea in my head, but it probably normalised it slightly.” (Kevin Lines 233-35). This normalisation of self-harming behaviour is important, in the interests of fairness, as to the effects of bullying. Kevin may have started cutting because of the bullying and his low esteem, but he may have continued because it may have given him a sense of belonging within a peer group (Copes and Williams, 2007). Likewise, his cutting could also be a way of coping with the stress of being bullied (McAndrew and Warne, 2014). Or it can be offered as an example of fitting in with his friends at that time, an example of Connell and Messerschmidt’s (2005) expansion of hegemonic groups to local levels. This could still be argued within peer groups which were of mixed gender. Kevin’s self-harming behaviour did not start and end with cutting, as in his teenage years he started various forms of binging and purging behaviours, sometimes together, sometimes independently. This continued intermediately into his twenties, with Kevin describing such binges as;

A binge to me, when it was at its worse as a bulimic kind of thing would be several tubs of ice cream plus half a shelf of cakes or cream cakes and stuff. I could easily go through £20 or £30 of food in one go (Kevin Lines 97-102).

8.2.5 -THE DRIVE WHICH PUSHES KEVIN

A common trait associated with people with anorexia is that of being driven or high achievement. In some ways Kevin appeared quite guarded about his past and only shared some basic facts about his early years and time at university. However, it could be assumed academically he must have been a high achiever as he held a post-graduate degree. He had also been selected for graduate training schemes which are often

competitive, with academic requirements being high to be selected just for an interview on such schemes.

Whilst Kevin did not specifically say what his job was, he did say that he had management responsibility directly and indirectly for around fifteen staff, indicating that he was at least a mid-level manager. He also spoke of a security clearance and on his demographic

questionnaire identified working in the civil service. What can be interpreted with some assurance is that Kevin’s position was one of responsibility and was likely to have required good academic achievements, drive and ambition.

A further example of Kevin’s drive, ability to focus and, in a way take control of his life, is his vegetarianism. Kevin became a vegetarian at the age of 21 whilst at university. He stated that he made the decision when not in the thralls of an ED and during one of his happier times of his life. Kevin’s vegetarianism has raised questions within his treatment and he stated; “I have had long involved discussions with my dietician about if my vegetarianism was just a cover for my eating disorder or am I actually a veggie.” (Kevin, Lines 243-44). In Kevin’s mind, his vegetarianism and ED were totally separate and not a form of covert restriction as suggested in discussions with his dietician. However, Kevin did state that he believed his vegetarianism does, and did, make food restriction easier, as many foods were not allowed. He gave a specific example of when buying sandwiches for his dinner; his only option from the retailer was one vegetarian low-calorie sandwich. However, this suggested he only used one retailer, thus perhaps unconsciously restricting his options further. Another reason why Kevin believed vegetarianism made food

restriction easier was because it “probably actively channelled me into following those rules type behaviour,” (Kevin Lines 250-51) meaning that he was more conditioned and better able to cut foods from his diet.

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KEVIN’S ED MANIFESTATION

Kevin’s ED (binge and purge) behaviours were intermittent, coming and going at various points in his life. However, he identified that in 2010 his behaviours stayed and food restriction started. In addition to food restriction, he also exercised, running between 30- 40km a week, reflecting; “I ran not an excessive amount, if you were training for a marathon, but an excessive amount if you are trying to eat 1200 calories a day” (Kevin Lines 108-110). His binging and purging also got out of control, to the point where he was binging and purging 10-15 times a day and weighing himself two to three times daily. This was the catalyst for him to seek help, but it had taken two and half to three years of these behaviours for him to do so. Kevin felt that his most recent bout of ED behaviour was an attempt for; “counter-acting things, the stress of work, depression.” (Kevin Line 111-112). However, while not verbalised by Kevin, his last romantic relationship ended in 2010 (Kevin Line 285), and this might have impacted on his deterioration in terms of his ED.

8.3.1 -THE GOAL

According to Kevin, the goal of his ED “wasn’t so much about trying to get thin” (Kevin Line 481-82). He continued “I have never been muscly and never tried to be muscly …having said that, always, sort of, part of my self-image of me was fat and weak, it was about being skinny” (Kevin Lines 482-83). As a bisexual man, Kevin’s opinion was interesting; research suggests that gay men tend to try to be thinner, whilst straight men want to increase muscle (Cooperman, 2000; Núñez-Navarro et al., 2012). Although Kevin was not homosexual, his drive for thinness was much more in line with gay men. This could be for a number of reasons, one being that when describing his masculinity Kevin said that he “celebrated not conforming to butch male stereotypes” (Kevin Lines 155-56) and it may account for his desire to study feminist theory.

8.3.2 -FACING THE PROBLEM...ALONE

For many of the men interviewed, the influence of loved ones had been a motivating factor to seek help and overcome the ED. Kevin seemed not to fall into this category. Whether

to go” (Kevin Line 56). Nobody telling Kevin to go to the doctors paints an evocative picture of his life; many of the other men had people close to them showing concern. In Kevin’s case this appears to have been absent regardless of his weight loss and changes in his behaviour being apparent. It is strange that not one of his friends, family or work colleagues asked or made suggestions about his health, perhaps reinforcing his isolation. By Kevin’s own admission he did not want people to know about his ED; “I just thought that it is a massive sign of weakness, this is something I should be able to cope with myself and without help” (Kevin Lines 365-66). Kevin also curtailed his social life and at work tried to put on an act. Kevin appeared to keep his private life private, as he was full of shame for having a “female illness”. When Kevin did tell people, he found they were aware he had problems and he was disappointed they had not said anything (8.5.2); perhaps they were scared to say something. One question which stemmed from this was his relationship with his family, as it took approximately four years from beginning restriction to telling them.

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REACHING OUT FOR MEDICAL HELP

I knew I had an eating disorder... I sort of knew that partly through the weight loss and partly through I had got to the point where I was weighing myself several times a day and restricting my calories I was eating. So, it was pretty clear to the rational part of my brain that I knew I was not well (Kevin Lines 49-55).

With these sentiments, and after approximately two and a half years of food restriction, Kevin sought out medical help by going to his GP. Kevin felt that his GP at first “looked a bit non-plus” (Kevin Line 50) at his disclosure. His doctor’s next reaction was to give him a test for depression and to then refer him to a community mental health team, who

subsequently referred him to a specialist ED service. From the outside it seems strange that a person goes to their doctor describing an ED and is firstly tested for depression, and then referred to a generic community mental health team, rather than being referred directly to the ED service. While this may have been standard procedure within this particular NHS trust, some academics have highlighted that men struggle to access treatment at times, because GPs do not necessarily recognise EDs in men (Paterson, 2004; Soban, 2006; Brown, 2007). For Kevin, from first going to see his doctor to being diagnosed by an ED service took approximately three to four months.

8.4.1 -WHERE DO I PEE?

During some episodes of treatment, Kevin said he was the only male patient and at times this was difficult for practical reasons. “Being the only bloke can be difficult, stupid things like there isn’t a male patient toilet, I had to use the disabled toilet, so I am abnormal that way!” (Kevin Lines 450-52). When Kevin reflected upon this he added; “but on the other hand it’s a good corrective for 2000 years of patriarchy, so I can’t complain that much” (Kevin Lines 452-53), perhaps indicating a touch of humour, or it could potentially illustrate how he views himself as a second-class citizen and not worthy of being equal. This indifference to Kevin’s gender was further exemplified when he disclosed that he had asked to have copies of paper work sent between practitioners. Kevin received standard letters from the ED unit sent to his GP in which Kevin was described as ‘she’ (Kevin additional email 16th April 2015). Perhaps a harmless mistake, but for a man in Kevin’s position perhaps it is further evidence of him suffering from a female illness.

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SHAME, AVOIDANCE, AWARENESS AND A

LITTLE ANGER – REACTIONS TO KEVIN’S ED

The reactions that Kevin had to his ED were on the whole positive, with perhaps the most negative ones being his own.

8.5.1 -KEVIN’S REACTION

Shame, because I…, yes, shame was the big thing; I see it as a big sign of weakness that I am suffering from depression and suffering from an eating disorder and I didn’t think anyone would understand. I still blame myself for having it, there is still a part of me that says ‘you knew’ (Kevin Lines 355-58).

Whilst Kevin identified that his behaviour escalated in 2010, it took him until 2013 to seek help. But in 2011, Kevin said, he was fully aware of what he was doing. Kevin’s shame is understandable, however it shows the power of emotion, as within Kevin’s group of friends in the LGBT community he stated that a number of them had suffered mental health problems, yet he still felt the stigma of his illness.

disclosing. On a personal level, he only told his best friend two months after being

diagnosed, his other friends twelve months after diagnosis and his family eighteen months after his first treatment. This reluctance to share or even trust those in his personal life with his ED is perhaps an example of the stigma many authors have reported (Weltzin et al., 2005). Kevin also spoke of a mask (coping strategy) he wore behind which he tried to hide all emotion. Kevin believed this had evolved from being bullied during his school days, which is consistent with Ramirez (2013) who identified masking being used by victims of school bullying. Kevin’s desire to keep his ED private brings into question his

relationships, particularly with his family, who he did not confide in until 18 months after his first treatment. This could indicate a lack of closeness or perhaps Kevin did not want to “burden them” with his problem.

Refusing to show others his “weakness”, in Kevin’s case his ED, is a trait often ascribed to masculinity (Connell, 1995). However, this is gender stereotyping evident in society. Rightly or wrongly however, with social conditioning, it is conceivable that Kevin may have consciously or unconsciously not wanted to feel more emasculated than he already felt. On this note Kevin said that he cared deeply about what his friends thought of him, admitting he probably cared too much. He stated; “I just thought that it is a massive sign of weakness. This is something I should be able to cope with myself and without help” (Kevin Lines 361-66). When Kevin did tell his friends, he was surprised at their reaction, especially as he had tried to hide it.

8.5.2 -FRIENDS’ REACTIONS

It took Kevin around twelve months to inform most of his friends about his ED and when he did he was surprised by their general reactions saying; “lots of people said ‘yes we were