Transcript: Hadley Freeman

My interview with the acclaimed author and columnist

Since the pandemic, we’ve been hearing more and more about the mental health crisis impacting teenaged girls. My guest on the program this week is a journalist with a special interest in the well-being of young women. In her own adolescence, she was hospitalized nine times for anorexia — which she’s written about in a new book — and in recent years, she has dug into the issue of gender dysphoria, trying to understand the surge of cases among teen girls. It was coverage of gender issues that ultimately led her to part ways with The Guardian, after 22 years with the paper.

Hadley Freeman is a columnist and features writer for the The Sunday Times in London, and a bestselling author. Her latest book is Good Girls: A Story and Study of Anorexia.

This is an edited transcript for paid subscribers. You can listen to the interview for free here.

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TH: Hadley, welcome to Lean Out.

HF: Thank you so much, Tara. I'm so thrilled to be here.

TH: I'm really excited to have you on. This is a remarkable book, it's great to get a chance to speak about it today. I want to start with this: Anorexia was very common when I was growing up. I'm Gen X, and I did know girls who were hospitalized for it. But in recent years, we have heard less about this. I was surprised to read that rates of anorexia are going up for children under 12. And then, not surprised to read that during the pandemic there was a rise in hospital referrals. To start today, walk us through how common anorexia is in 2023 — and who is most likely to suffer from the illness.

HF: Well, the rates of anorexia have generally stayed about the same. In Britain at least, it's about 1% of the female population suffer from anorexia. Like you say, the hospital referrals have gone up, particularly during the pandemic. It is suffered by boys and men. They represent about 10% of the patients, according to all the doctors I spoke to in Britain. But it's generally suffered by girls and women, and it almost invariably starts around adolescence, puberty.

TH: To think through the topic, you go through your own personal story, as well as the stories of young women that you met in the hospital. For listeners, for context, starting at 14, you had nine psychiatric hospital stays, about two and a half years, with brief stays at home in between. There was one line that stood out so much to me from the book: “So much of anorexia is about suppressed conversations.” Talk to me about that, and how that played into your own personal story.

HF: I actually can't take credit for that line. That came from the ward manager of one of the eating disorder wards that I was on. What she meant was that anorexia is a way for girls and women — I'm just going to say girls and women, for ease of communication, but I am aware that boys and men get it too. It's the way that girls and women express something without having to articulate it. Because I think a lot of girls find it very hard to say what would be "unpleasant feelings." To voice unpleasant feelings — whether it's anger, sadness, fear, self-loathing, shame. Instead, they express it through their bodies. This is why I find it shockingly simplistic when people describe anorexia as a desire to be thin.

I know that is what anorexics say when they are in the grip of the disease, but it is not about that. It's about wanting to look ill, so that people know something is wrong with you without having to say it.

TH: That's just so striking to me. Also, there is this theme of wanting to opt out of the world in general and wanting to opt out of womanhood in particular. Another striking paragraph is where you're quoting two doctors. You write, "They cite as external factors the Internet, in particular Instagram and online pornography, both of which, in their own ways, make some girls feel that they just don't fit in as females. This is a feeling many anorexics can relate to. The sense that your body is making promises to the outside world that you can't keep." Tell me more about that — and how that played out for you.

HF: Well, I certainly felt that. Those two doctors, Dr. Anna Hutchinson and Melissa Midgen, worked in both youth gender care and also with eating disorders. They were talking about that desire, that a lot of girls feel, not to be women. I was absolutely terrified of becoming a woman, and that underpins so much of anorexia. Which is why, as I said, it generally starts during puberty. I was quite emotionally immature for a 14-year-old, which is when it started with me.

But I think a lot of young girls find it very hard to be a woman and to see their body changing and seeing boys and men reacting to their bodies in a different way — not knowing what that means. Not knowing really what sex means, necessarily. Obviously, they know what sex is, but [they don't know] what they're supposed to do. It is a very scary time, and I think people forget that with a lot of girls. Because we idealize young female beauty so much, we forget how scared a lot of girls feel inside when they're suddenly looking physically sexually available and they don't feel that way yet. For a lot, anorexia is about trying not to be a woman. Trying to stay a child, really.

TH: One of the things that's incredible about this book is it is a very hopeful story. You did make a full recovery. That is a wonderful thing to read about. So that readers understand, where did the illness ultimately take you? What did your lowest points look like for you?

HF: As you said, I was in hospital nine times. I think there was one two-week stay, but generally, they were three to six months. The lowest point was when I'd been dropped by my first psychiatrist after a year of treatment from him, because I wouldn't drop out of school to focus on my recovery. I didn't really have anyone looking after me other than our family doctor, what we call a GP in Britain. My weight dropped so low that my heart was stopping working.

I was having really bad arrhythmia and palpitations because my heart was cannibalizing itself, really, and I was fainting all the time in the streets and at school. That was when our family doctor yanked me out of school and put me in a general hospital, which is the worst place for an anorexic. That was definitely at my lowest weight. I had almost no hair. At this point, most of my hair had fallen out. I had body hair growing all over my body in an attempt to keep me warm. My lips were cracked and bleeding. My knuckles were all bleeding, because I also had OCD hand washing. I was no one's idea of a beauty at that point. I looked basically like roadkill.

TH: It was interesting for me to read that the hospital was a safe place for you, that you enjoyed being there. And that one of the turning points was your doctor saying to you, "If you lose weight, I'm not putting you back in the hospital. You have to stay at home, and eat at home, and have a nurse assigned to you at home." Talk to me about what it felt like being in the hospital with these other young women — and why that was such a turning point for you.

HF: At times, of course, being in hospital is terrible for anyone suffering from anorexia. You have to eat, you have to put on weight. You're surrounded by other girls and women who have anorexia. Sometimes you get support from the other patients and other times it can be full of bullying, because no one knows how to bully an anorexic better than another anorexic. There can be a lot of teasing about who weighs more, who had the bigger portion at lunch, all that kind of stuff.

But the secret that patients with anorexia don't want to say, ever, is that being in hospital is preferable to being at home because in hospitals someone is making you eat. It's not your fault. You don't have to feel guilty about it. It's not your responsibility. It's not your fault that you're not exercising 18 hours a day. It's not your fault that you're not able to throw up after eating all the time. It's someone else's responsibility.

It sounds counterintuitive, but that is a huge relief for a lot of girls and women with this eating disorder. Because they just can't bear the guilt of eating themselves. So it's great for someone to make them do it, so they don't have to deal with it. The reason it was such a turning point for me — when my therapist said to me after my ninth admission, and I was losing weight at home again, and she said to me, "I'm not going to put you back in hospital, because I think it's too comfortable for you there now. You'd have a nurse at home."

This was unbearable to me. The idea of being in the outside world, constantly overlooked by a nurse, living with my parents, everyone knowing I'm eating in the outside world — which to me was the biggest shame of all, to show that I have an appetite, to outside people. At least in hospital, we all know it's not our fault. In the outside world, it would look voluntary that I was eating. That was it for me. I couldn't do it. I realized I couldn't bear to have that situation in the outside world. I'd rather feed myself just enough to stay the same way and go back to school, which is what I wanted to do.

TH: Another turning point that really stood out was when you were in the hospital, a woman having a meltdown at a meal. Walk me through that moment and why that offered a little hope.

HF: It is very strange what will trigger someone's recovery, in the same way it's very unexpected what will trigger someone's descent into the illness. For me it was, I was sitting in the dining room. We all ate together, all the patients, our three meals and three snacks a day. The woman opposite me just had her 32nd birthday. We were eating breakfast and she started having this real screaming, crying fit about that she felt there was more butter on her toast than on anyone else's.

This happened at every single meal. Someone would feel they had a bigger piece of pie, or they have more roast potatoes or something. We were all always comparing our plates. I looked at her and this thought just came into my head. It was, "I will not be having tantrums over toast when I'm 32 years old." I was 17 then. That was the first time in about three years that I thought, "Maybe this doesn't have to be my life."

Before that I thought, "This will be my life. I will be like these other women in the hospital with me who were all in their 40s and 50s and had spent their entire lives going in and out of hospital." I thought, "Well, that'll be me, because I can't bear the guilt of feeding myself in the outside world. I'd rather be fed up in the hospital, go out, lose the weight again, then go back into hospital. And be stuck in that cycle.” Which more women than people realize — that is how their lives are. That was a moment when I thought, "No, this is not going to be my life."

TH: It was significant, too, that you decided to stay in school. And that was a lifeline for you. This vision of a different life begins to emerge. You're still struggling but you write, "I was spending 16 hours a day learning French vocabulary and the dates of Renaissance paintings, but only six months earlier I could never have imagined such freedom." Tell us what your life was like during that period.

HF: That was when I went to boarding school. I was in the senior year of high school at that point, and I was doing two years in one. It was a special school, mainly for kids who had been thrown out of their previous school. I was eating the same food every single day because I thought if it didn't put on weight the day before, it won't put on weight today. I had kept a little drinks cooler in my room, where I could keep all my yogurts and bags of vegetables that I would snack on.

I just felt elated. I couldn't believe it. I had gotten out of hospital. I was having a normal-ish life. No one would look at me and they go, "That's a typical 18-year-old." But I had friends who weren't psychiatric patients. I was going to French and history of art and English literature lessons. I was applying to university. This was a life that had seemed impossible just a few months before, and suddenly it was stretching out in front of me.

TH: You do go to university and then afterwards you become a fashion journalist. I loved reading about that. Of course, in some ways that is the belly of the beast, in terms of body image issues. Given the climate of safetyism that we're in right now, one might think that you would avoid that. But you didn't, and it didn't cause you to relapse. What are your thoughts on why?

HF: I know why people find it strange that I become fashion journalist. The thing is, fashion models, fashion magazines, they never played any part at all in my illness. When I became ill at 14, I'd never even looked at a fashion magazine. I had no idea who Cindy Crawford and Kate Moss were. They weren't [on my radar] at all. People do think, "Oh, this causes eating disorders ..." Those kind of triggers, I do think, are irrelevant. I really do. I say at the beginning of the book, the thing that triggered me was just a friend at school. A very thin friend saying that she wished she was normal-sized like me. To me, that totally spun me out.

The next thing that spun me out was I was watching When Harry Met Sally with my parents, and there's a scene in it when Harry and Sally have bumped into Harry's ex-wife and Harry says, "Her legs look bigger. Do you think she's retaining water?" Anyone else would think like, "Haha, Harry is trying to make himself better by suggesting his wife looks like dumpy or something." But to me, I thought, "Oh, my God, I need to worry about how my legs look, not just my stomach. Oh, my God, water puts on weight."

You can't predict what triggers are. I do think people's obsession with triggers is basically a grasp for control that doesn't exist.

I understand why people look at the fashion world and think its obsession with female thinness is weird, and I agree with that. I do think it's weird. I think the fashion world's obsession with thinness, it is articulating a cultural language around us and enhancing it. And anorexia is an expression of unhappiness that uses the cultural language of not eating.

There is a connection between the two, but it's really simplistic to say Vogue or fashion causes eating disorders. In any case, I've also interviewed a lot of celebrities, and I have met far more celebrities with clear eating disorders than any fashion model that I ever came across in my 10 years at the fashion desk.

TH: In this book, you do also touch on gender issues. Reading your memoir, it makes perfect sense why you have become interested in these issues, and in this debate over transgenderism. You write at one point, “Eating disorders and gender dysphoria are disorders of the body: body obsession, body hatred, body alienation.” When did you first start getting interested in this topic, and what made you decide to take this on?