Constance Barter seems like an entirely different person from the girl whose diary I had read, and which is about to be published. She is about to turn 17, and is vibrant and chatty, talking enthusiastically about her A-levels next year and what she wants to do in the future. She is a world away from the 14-year-old who was starving herself to death. "I just don't see the point of living any more," she wrote in the first entry in August 2007, "I feel worthless." By that point, she had been in a specialist eating disorders treatment unit near her home in Hampshire for a month. Just before that, she had been admitted to hospital where, close to death and delirious, she was put on a drip for a week.
Constance isn't sure when, or why, she developed anorexia. "It would be unrealistic to try to work out why I had the illness," she says now, sitting on a footstool by her mother, helping herself to a biscuit, but after reading her book, in which she details the intense struggle to eat a single piece of chocolate or even take a sip of water from a plastic medicine cup, it leaves you in no doubt that she has come a long way. An only child, she says she had a very happy, stable childhood with her mother, Sarah, and father, Clive. "I remember her friends saying 'Constance is so pretty, clever, popular – why is she doing this to herself?'" says Sarah. There is no answer, says Constance.
About one in 150 girls of 15 has anorexia nervosa, and in extreme cases it can be fatal. There are certain character traits that are associated with the illness, such as perfectionism and drive – both things that Constance says she has. She was never satisfied with her straight-A school grades and says she never felt good enough. She started running and was soon running for her county – once she realised she was losing weight, this became the perfect excuse to train incessantly (at one point she was running 25km and swimming 6km every week). She was eating less and less, which was easy for her to do without anybody noticing because she was at boarding school during the week. "I used to dread school holidays," she says, "because I knew I would have to eat. I became a really good liar and I would lie to my friends about how much I had eaten, and how far I had run." This continued until she started to faint and her friends told a teacher. In April 2007, a school doctor examined her and asked if she was anorexic. "I just said no. I phoned Mum in tears. She only saw me at weekends and saw me eating – and said 'That's ridiculous.'"
Sarah didn't know what was wrong with her daughter. "She was eating normally, as far as we knew. She was the only one who knew what was going on and the rest of us were in this wake of lies. She was exhausted the whole time." Glandular fever was mentioned, and chronic fatigue.
Constance was taken to see an ophthalmologist because her vision suffered during fainting fits. "It sounds like it must have been so obvious what was wrong with her, but it wasn't," says Sarah. "I had never known anyone who had anorexia and it wasn't really on my radar. In May, I finally begged her to tell me what was wrong."
Constance confessed that she hated herself and the way she looked, and that she wasn't eating.
She was officially diagnosed, but it was still a shock for the family. "I still thought it was ridiculous," says Sarah. "We're a family that likes food, likes eating, likes cooking. It was sheer shock and disbelief, and I had the naive view that anorexics don't like their food. I didn't understand the illness, but once we realised that it was a mental illness it helped us to deal with it."
Constance was seen by the hospital, who created a meal plan for her to follow at home, but it became impossible for Sarah and her husband to cope. "Your normal life grinds to a halt. She was argumentative, depressed, distraught, sometimes very, very scared. And then she would be funny and brilliant, only to be worse the next day, as a kind of punishment to herself. It was exhausting, everything – trying to support her, trying to keep our marriage together."
Mealtimes were a battlefield. "We would get through one meal and then wonder how we would have the stamina to get through another," she says. "I would say things like 'This isn't going to make you fat, this is keeping you alive.' But you're not dealing with a sane, rational person. You're dealing with somebody who doesn't want to do what they need to do to survive."
Sarah describes her daughter as "terrifyingly ill" when she admitted her to hospital in July 2007. Constance doesn't want to say how little she weighed because she says anorexia is a competitive illness and she doesn't want to influence other sufferers. But by this point, she was refusing to even drink water and was put on a drip. Her heart had slowed and doctors warned her she would die if she continued to refuse to eat. Did Sarah think she would? She nods. "That didn't mean anything to me," says Constance, "because this thing inside me was so strong and powerful – it was saying 'They're threatening you, they're just saying that, it doesn't mean anything.'
"I knew what I was putting myself through because I was so weak, but this voice inside me was saying 'This will make you a better person, you're doing so well.' Every muscle that aches congratulates you." She had succeeded in becoming, she says, a "good anorexic".
During the seven months Constance was in the specialist unit, she was put on a feeding tube three times, often for weeks at a time, during the periods when she refused to eat. In the early entries of her diary, she often writes about wanting to die. That must have been terrible for Sarah to read. "It was, but she had said those things to me. It makes you feel completely distraught and helpless, but you have to remind yourself that it wasn't Constance, it was her illness, and for a time, it had eclipsed her. Every ounce of energy was put in to trying to haul her back."
Through those long months of therapy, the support of her family and friends, and eventually sticking to the meal plans, Constance started to get better. Family therapy with her parents helped. Before she became ill, her family was "close, chatty, social, bubbly," says Constance. "For me, [family therapy] was about understanding why I was so frightened of expressing any negative feelings. Somehow I had thought shouting and anger were really bad and I couldn't show them to anyone, that it would mean I wasn't a good person. Part of the family work was about unlocking that and realising that you are allowed to be grumpy or scared and it's a normal human emotion. Not being afraid to say, 'Mum, I'm feeling quite sad today,' rather than having to struggle on my own and having to feel I had to be happy the whole time."
In March last year, 13 months after Constance was discharged, her father was diagnosed with cancer and died just three months later. They mention him a lot, and it is clearly still a painful subject. "If Daddy had died while I was ill, I don't think I would have come out the other side," says Constance. She looks at her mother, who says: "We have been destroyed, but we've also been rebuilt." Now it is clear that they are very close. "We're like peas in a pod," says Constance. She kept a diary while she was having treatment. After her recovery, she became a young ambassador for Beat, the charity for people with eating disorders, and decided she wanted to publish her account. "My main hope is to provide hope and inspiration to other young sufferers," she says. "And to show it is possible to make a full recovery. I have a very strong belief that I will never return to anorexia. I don't think any of us can ever really trust the illness, but I think what I've been through with Dad shows it's not part of our lives any more, because that would have been the moment when it came back. I have such painful memories of what being ill with anorexia is. My life is so much more fun and free without it."
Mealtimes and Milestones: A Teenager's Diary of Moving on from Anorexia by Constance Barter is published by Robinson, £7.99. To order a copy for £7.99 with free UK p&p, go to theguardian.com/bookshop or call 0330 3336846
