“I don’t know why you have to be immature about it.” I put my foot in it again. Opened my big mouth.

“Don’t you dare call me immature, you don’t understand it’s hard for me.” My sister erupts into a flood of tears and walks out of the room. I sit contemplating.

Anyone else would have probably shrugged off the comment or started a slanging match. Even if they felt angry, crying would probably not have been their first reaction. “Alhamdulillah,” I murmur under my breath. Accidentally throwing away the salt of my sister, a depressive anorexic sufferer, and consequently making such a comment was not the best idea, especially as it involved food.

Whatever path of life you are in, you will no doubt come across, directly or indirectly, those who suffer from depression or an eating disorder, sometimes both. Having lived with a sister who has suffered from both clinical depression and anorexia for at least 5 years and having visited the many clinics and attended counselling sessions involved, I have discovered that clinical depression and eating disorders are more common in today’s society than we think.

Eating disorders, such as anorexia, are serious illnesses affecting 1.6 million people in the UK alone [1], and around 5% of all cases of anorexia will be fatal [2]. When it comes to depression, 8-12% of the population experience depression in any year [3].

What are Depression and Anorexia?

Depression is a state of mind characterised by a combination of short or long-term sadness, worthlessness, disinterest in normal life, lack of motivation and other negative feelings.

Anorexia Nervosa is an eating disorder characterised by a great fear of gaining weight, which leads to self-starvation. Anorexia alone means a loss of appetite.

Why does it happen?

For both illnesses, there are many causes, some of which cannot be identified. Depression can be caused by negative thinking, a lack of self-esteem, traumatic events and problems such as child abuse, financial problems and bad health. Both biological and situational factors may contribute to the illness. Clinical depression, what my sister suffered from, is a type of depression caused by an imbalance or lack of chemicals that move between the brain cells.

Normally, anorexia can be caused by these things too, as well as by the effects of clinical depression itself. Anorexia can also be caused by the pressure to live up to a modern ideal of beauty that is often portrayed in the media, as well as bullying or peer pressure. Family members of sufferers are more likely to develop anorexia, and as with clinical depression, genes, hormones and chemicals in the brain can also play a part.

In my sister’s case, the depression came first, and as a result, she turned to food as a means to “control” her feelings. The causes are not always so clear cut. After years of counselling sessions, we know that my sister’s depression was most probably caused by a mixture of triggers, including me and my cousin (who was close to my sister) growing up and becoming less close to her, her best friend moving away, and her personality: my sister was always a perfectionist, had low self esteem, couldn’t cope with change and found it hard to deal with feelings of anger and stress.

Testing Times

Talking to the sufferer without effect

On many many occasions, I remember my whole family staying in my sister’s room for hours, trying to get her to understand that she is not a “bad person who deserves to die”. It can be frustrating and sad to see how such an illness takes hold of someone you know well, and conversations tend to go in circles. In the depths of depression, my sister often used to lie curled up on her bedroom floor for hours, just crying. A hug simply cannot change the situation.

Finding yourself becoming distant to the sufferer

When someone suffers from depression or anorexia, they may feel completely isolated, regardless of how many people are with them. With illogical thoughts controlling their minds, it can become very hard to relate to the sufferer. On the other hand, seeing someone close suffer from such a dreaded illness can help you realise how important they are to you.

Following the sufferer’s routine when in their company

Anorexics tend to have “rules” that they “have” to follow. They have to eat at a certain time, exercise at a certain time etc. I remember my sister once said that I have similar traits to an anorexic because I follow rituals such as praying five times a day! Once you become used to their routine, it is ok alhamdulillah, especially if they are able to eat in public places (which is not always the case).

Constantly looking out for the sufferer’s well-being

Being around someone with depression or anorexia means that, a lot of the time, you feel you have a great responsibility to look after them. I remember when we were at college together, (my sister had been put back a year due to hospital admissions, so I was in the same year as her), if she was five minutes late at break, or seemed to disappear for a while, I got extremely worried. Where was she? Was she with the razor blades in the school toilets? Was she running around the school grounds trying to burn off calories? Had she collapsed somewhere?

I will never forget one particular time, when I was praying and although a sign was on the door asking people not to enter, my teacher started knocking and then opened the door. Finishing my Salaah, she told me that my sister could not be “located” and that she had been seen by the bell tower which had a rope. My blood froze. I knew that my sister was against suicide, but could her low state cause her irrational thoughts to take over? I wasn’t sure. In reality, my sister was in the IT rooms all the time we were searching the school grounds for her, but it was a very scary situation nevertheless.

Tiptoeing around

When around the sufferer, it sometimes feels that you are constantly avoiding making a mistake, sometimes leading you to speak less. For those suffering from depression or anorexia, small comments can affect them drastically. One time, one of our classmates at school was cutting out stick men, and happened to cut one out that was more stick-like than normal. She said something on the lines of “that one’s too thin and stupid” and then expressed her guilt afterwards, telling me how she hoped she hadn’t put her foot in it and upset my sister.

How I helped my sister

• It was important to remind my sister that I was always there for her. Of course this was hard at times, especially if she didn't want to talk much or couldn't due to her strong negative feelings. Keeping in regular contact through texts and hospital visits helped lift her spirits.
• It was important for my family to accompany my sister to appointments and counselling sessions for moral support. Being active in helping her showed her that we cared about her. Through family therapy I learned a lot about the illness and came to understand the behaviour of my sister a lot better.
• As my sister also had depression, it was vital to try and boost her self-esteem by demonstrating her positive points. Admittedly, the sick person will not always accept or believe the positive points others give, but it is certainly a step in the right direction.
• Talking about the illness 24/7 certainly doesn't help. I remember that my sister said I helped her more than my parents at times, because I tried to distract her from the illness and give her some time out.
• We had to be firm with my sister to protect her health, even if this seemed mean. At one point, my Dad took away my sister's car keys because she was too low in weight to drive safely.
• Creating a safe environment is one of the most important aspects of helping the sufferer. We hid all kitchen knives, razor blades etc. and even searched my sister's bag to ensure she wasn't hiding anything she could use to self-harm.
• I tried to offer to go out with my sister (never forcing), which sometimes distracted her and eased her sense of isolation, even if it didn't change her mood greatly.
• As well as watching out for my sister and being aware of her behaviour, sufferers need their space. Sometimes I think I was too protective and stalker-like, beginning to worry about the whereabouts of my sibling even though she was safely studying somewhere at school. Another depressive girl in my school gave us signs to her lack of well-being even though she didn't directly ask for help. It is important to act on such signs and alert someone should you notice anything worrying such as comments about suicide.
• I was surprised by how much small things such as a note or gift meant to my sister. My sister’s classmates sent her a bracelet and different charms every week masha'Allah, which always lightened her mood.
• As my family gained experience with my sister's behaviour, we realised the importance of directing our frustration onto the illness, rather than onto her. Instead of calling her irrational, we would call the illness irrational. This saved us from offending when the behaviour was really out of my sister's control.
• At one point, my sister discharged herself from hospital, despite doctors' advice. It is therefore important to encourage sufferers to help themselves and have treatment: doctors (generally) know best!
• Although my sister was non-Muslim, I encouraged her to pray, as she believes in God, alhamdulillah. If the sick person is Muslim, remind them that Allah (subhaanahu wa ta'aala) is the Only One who can cure them; encourage them to make du’aa and become closer to Him.

How I coped being the sister of a sufferer

• I coped first and foremost through experience and gaining knowledge about the illness - even though I was unable to directly relate to my sister's feelings. My understanding had a direct effect on the extent to which I could help my sister.
• I talked to professionals and attended family sessions, which did somewhat ease my mind. It is natural to feel scared, overwhelmed, and sometimes alone, especially if your parents are spending more of their time on a sick sibling. There is no need to feel guilty for such feelings, it is your every right to have these feelings and fully express your emotions and fears.
• As I became accustomed to the changed behaviour of my sibling, I had to remind myself that she had been taken over by this terrible sickness and, in fact, it was the voice of “Anna” (Anorexia) who was in control. Although this was a frightening thought, it made it easier to not take anything personally.
• At school especially, I felt it was my responsibility to take care of my sister. However, I knew it was important for my own health and well-being to take time out and care for myself too. Things could get stressful and I sometimes needed to re-energise myself.
• At the time when my sister was most sick, Allah (subhaanahu wa ta'aala) gave me a close companion in whom I could confide, subhan'Allah. I think that it always helps to open up to others and talk to those who understand you. I found it easier to talk to non-family members about my sister's illness. Although I didn't really talk to other siblings who were in the same situation as me, I think this can also be useful. At any rate, don’t try and solve the sufferer’s problems by yourself.
• At first, I partly blamed myself for my sister's illness, because I contemplated how I hadn't been there for her much. At the same time, I knew it wasn't just this factor which had led to her illness, and it was the Decree of Allah (subhaanahu wa ta'aala). If I said something slightly insensitive which upset my sister, I remembered that my intention had been good.
• For any sadness, anxiety or hardship that I faced, I knew that Allah (subhaanahu wa ta'aala) would forgive my sins through it, insha'Allah, so it was actually a blessing in disguise! The Prophets ('alayhim assalaam) and the pious predecessors (radiyAllahu 'anhum) suffered the most hardships and Allah (subhaanahu wa ta'aala) loves those He tests.

Anas (radiyAllahu 'anhu) reported that the Prophet (salallahu 'alayhi wa sallam) said: "The amount of reward is in accordance with the amount of suffering. When Allah (subhaanahu wa ta'aala) loves some people, He tries them (with afflictions)..."[At-Tirmidhi]

Abu Hurairah (radiyAllahu 'anhu) reported that the Prophet (salallahu 'alayhi wa sallam) said, “Hardships continue to befall a believing man and woman in their body, family, and property, until they meet Allah burdened with no sins.” [At-Tirmidhi]

• Ultimately, it was Islam that helped me the most. I made du’aa, trying to become closer to Allah (subhaanahu wa ta'aala). When I had low times, I sat and cried to Allah (subhaanahu wa ta'aala); better than any counsellor or doctor. My Lord knew why I was sad, and He comforted me the most. In many ways, my belief as a Muslimah helped me cope a lot better than my other non-Muslim family members. I believed that there was a cure for every disease, and that Allah (subhaanahu wa ta'aala) was the Only One who could provide it.

Abu Hurayrah (radiyAllahu 'anhu) narrated that the Prophet (salallahu 'alayhi wa sallam) said: "There is no disease that Allah has created, except that He also has created its remedy." [Bukhari]

As with all sufferers, my sister has had her ups and downs, and is still going through them, but alhamdulillah she is a lot better than before. I would like to thank her for letting me write this account.

If you are worried that you or anyone else you know may be suffering from either illness, please see the Following Links for further information and/or help:

A past article in The Revival about Depression: Don't Worry, Be Happy

Beat (Beating eating disorders): http://www.b-eat.co.uk

National Centre For Eating Disorders: http://www.eating-disorders.org.uk

Mind – Mental Health Charity: http://www.mind.org.uk

Students Against Depression: http://www.studentdepression.org

Muslim Youth Helpline: http://www.myh.org.uk

Student Counselling in UK Universities: http://www.student.counselling.co.uk

Samaritans: http://www.samaritans.org

Counselling Directory page on Eating disorders: http://www.counselling-directory.org.uk/eating.html

References

1. http://www.b-eat.co.uk/Home
2. http://www.disordered-eating.co.uk/eating-disorders-statistics/anorexia-...
3. Office for National Statistics Psychiatric Morbidity report (2001)