In 1956, aged 31, Miriam Karlin was cast to play the Polish airwoman in Bernard Shaw's play Misalliance. But at the first rehearsal, she saw the design for her costume - "a sylph-like Marlene figure in trousers" - and panicked. She went straight to the actors' favourite diet doctor in her lunch break and told him that she needed to lose two stone in four weeks. He gave her "a diet sheet and a whole load of funny coloured pills [diuretics and speed]. You could practically hear me deflating." And that was the beginning of the rest of her life: 48 years of anorexia and bulimia, which has wrecked her health and which, she suspects, caused the peripheral neuropathy (PN) from which she now suffers.
"Until then I had always been a very big girl - between 11 and a half and 12 stone, with a perfectly happy life, sex and stuff," says Karlin. "But having lost two stone and suddenly finding bones I didn't know I had, and a new shape, I couldn't stop. I went on and on. I didn't want any food to stay inside my body for any length of time. Being sick never appealed to me, so I used the other orifice. I started taking laxatives. My periods stopped, but I didn't realise what I was doing to myself."
What she now thinks she may have been doing was depriving her body of all nutrients and vitamins. "I upped the laxatives even more over the years and spent a fortune buying vitamins, but obviously just flushed them all down the pan. I couldn't have done that for 48 years without it having caused some lasting damage. I can eat all the green vegetables I like, but it does me no good if I then shit them all away. I'm reluctant to talk too much about bowels, but I'm afraid bowels it is. I had always kidded myself that perhaps it was the riotous life I had led in the 50s and 60s that caused my PN (diagnosed in the 90s), but plenty of other actors did the same and they're all right."
Karlin, who is probably best known for her TV role in the The Rag Trade, is far from all right. "My legs, from my hips down to my toes, are burning, on edge, like electric shocks for most of the time. It's made walking and standing horrendous - very painful. The nerves feel raw, like an electric wire with the plastic coating taken off. I've had these pains for 15 or 20 years and they've got progressively worse. My sense of balance is appalling. It's also buggered up my bladder and a specialist told me 15 years ago that my bowels would never function independently again, and now I must take laxatives until the end of my days [of a type approved by the doctor]."
Peripheral neuropathy affects about 2.4% of the population and, according to the Neuropathy Trust, is not a specific disease, but rather a manifestation of many conditions that cause damage to the peripheral nerves. It results in a variety of different sensations, from numbness and pins and needles to excruciating and shooting pains - just one nerve may be affected or many, and it can be utterly disabling. It affects people with diabetes mellitus, HIV, nutritional deficiency and shingles, but in up to 40% of cases the cause is unknown.
Today Karlin speaks frankly about her bulimia and anorexia, but she only started doing so four weeks ago, when a friend offered her a tray of snacks. She refused them as usual, and the friend confronted her. "She just looked straight at me and said, 'You have an eating disorder,' and then she suggested a psychotherapist. I already had a lovely one, but I had never told him about it. My sister-in-law had tried to tell me but I took no notice. But now, for the first time, I realised that I had been in a state of denial about this for 48 years." Now Karlin has decided to come out of the closet.
"I'm doing this because nothing can make me the woman that I was, but it might stop others doing the same. I used to exercise and do loads of yoga; I was a very physical person, which is so galling, because anybody who meets me now for the first time sees this old woman with a stick. I've also made a connection between my anorexia and my neuropathy and I would dearly love to know if other people have behaved in the way that I have and ended up with PN."
She makes it quite clear that none of the neurological specialists she has seen has made the connection, but it seems highly plausible. PN can be caused by vitamin B12 deficiency and folic deficiency. Some of the stranger herbal remedies thatshe may have taken could have been neurotoxic, and she admits to having tried "all sorts of crazy diets". She took Preludin, an appetite suppressant available over the counter, until it was banned more than 30 years ago, as well as taking another senna-based laxative - "loads of it, every evening. Then, less than a year ago, it was also taken off the market. I nearly went mad. I started throwing Senokot down me at a rate of knots - 10 a night. But now I've stopped doing that."
But she hasn't stopped her dieting. "My psychotherapist thinks it's very good that I'm talking about it. Yesterday he asked me what I ate. Lunch is a couple of rice cakes, perhaps a bit of tahini spread over it. No dairy products, no wheat, no meat. I do have fish, usually in the evening, some free-range chicken. I don't combine protein and carbohydrates. Haven't done that for years. I wouldn't have rice with fish or chicken. I'd feel all bloated."
When Weight Watchers launched in the UK, she tried to join, but they wouldn't have her: she was too thin. "So I went away, put on weight, then I joined. I became totally obsessional about it, got my badge and left. It's bizarre, isn't it?" She went to a hypnotist to stop her cravings for biscuits, and she adored colonic irrigation. "It's a wonderful feeling. You never want to eat again, because you're absolutely defiling your body by putting food in there after it's been cleansed. I got away with all this for 25 years. I think I'm the oldest anorexic in the business. Are there people who started doing what I did in the 50s who are still at it?
"I feel that I've made a total cock-up of my life, and my career, really. All the lying and sitting-down [acting] parts are still fine. I think they should all be mine, provided they're of an age. I've just played a woman crippled with arthritis. Nobody can tell the difference." Her career is still hugely impressive - 58 years in the theatre, performing in Mother Courage, Fiddler on the Roof, Torch Song Trilogy, Mistress Quickly for the RSC ("I was really thin in Clockwork Orange"). She performed one-woman shows in Australia, Edinburgh and the Palace of Versailles; she was the only woman to play Pinter's Caretaker, was awarded an OBE in 1975 and, of course, she starred in The Rag Trade on television in the 60s and 70s.
People are aways nagging her to write her autobiography. "I can't bear actors' autobiogs," she says. "They're such a wank. But now I've thought of an opening: 'Having been a life member of the Voluntary Euthanasia Society for 30 years, I thought I'd write a book before invoking their assistance.' " Despite her health problems, Karlin is still an impressive activist. "I'm enraged about what's going on in the world," she says. "I belong to human rights organisations, I go to meetings, I'm still a paid-up member of CND, but because of my conditions I couldn't march.
"I don't want to take painkillers because they make me dopey, and I want to be in command of myself. I want to be alive, to be able to write letters to the Guardian and scream about Bush. I feel I've been betrayed by socialism and Israel. When I tell you all this, it sounds so crass, but I have to admit that prior to thinking daily about the whole Iraq war situation and what prats Bush and Blair are, I always think, 'Have I put on weight?' That is my first thought every day. Still, at the age of 78. And I'm deeply ashamed.
"I don't see that anybody could help me now, really. You can't mend damaged nerves. But if there's even one person out there doing what I have done, I just want them to stop. Mind you, if anyone had told me, in my 30s, that I'd be in screaming pain by now, I'd have told them to fuck off.
"How about a cup of tea?" she asks. "Go on. I fancy one too." With the tea she brings out a tray of biscuits. But they're only for me.
