Weighing a childlike 80 pounds as a law student, Angela Rinaldis wrote her final exams in a fog. The dotted line of bruises down her spine from carrying a backpack of books with no flesh to protect her bones finally made her sick of being sick. Then, a decade ago at age 24, she asked to be treated for anorexia at St. Paul’s Hospital — and now marvels at her survival.
“I constantly had to be in pain. I felt I deserved it,” Rinaldis said this week at her downtown Vancouver office, where she practises as a criminal defence lawyer.
She’s talking about the immense personal and social burden of her eating disorder with the hope it will encourage more people to speak out about the potentially deadly mental illness.
“No one wants to say they have an eating disorder. There was a point where I was uncomfortable, too,” says Rinaldis, a rapid-fire talker with an unflinching approach, even toward herself. “I’m a lawyer. I stand up in court. I work on big cases. I didn’t want people to think I’m crazy. I mean, I couldn’t eat a sandwich, but now I’m defending your rights.”
Silence also means there’s no open discussion about how to recover, she says.
“You can be cured of an eating disorder and then you can get back to working or going to school, gainfully engaged in society.”
It’s a topic important enough to occupy 22 members of parliament who listened to expert witnesses last year before producing a 75-page report that was released with no publicity in November and quickly shelved.
The Standing Committee on the Status of Women has examined issues it deems to be significant to the country including equal pay and violence against women.
The only other major health issue it has examined stretching back to 1992 is breast cancer. “The study shines a spotlight on an often marginalized and misunderstood mental health disorder which affects approximately 600,000 to 990,000 individuals, plus their families, at any given time in Canada,” says the report.
“Many witnesses noted that eating disorders, particularly anorexia nervosa, have the highest mortality rate of any mental illness,” it continues.
Between 10 and 15 per cent of people diagnosed with anorexia nervosa will die from it, as will five per cent of those with bulimia. Together, the disorders kill an estimated 1,000 to 1,500 Canadians per year.
And those numbers are considered low because deaths from heart attacks or suicide, for instance, are not necessarily counted as deaths from an eating disorder.
In one of 25 recommendations, the committee asked the federal government to work with the provinces to fund timely care — even if it means sending patients to the U.S. — because there is a shortage of treatment beds for these “life-threatening” illnesses.
The committee also heard that the incidence of eating disorders held steady from 2006 to 2013 in all but the youngest patients, with a 42-per-cent increase in hospitalization among girls aged 10-19 during the last two years of the study.
Experts say the causes of anorexia, bulimia and binge eating are complex, with genetic, psychological and cultural factors at play. It’s linked to isolation, poor coping skills, a need for control, perfectionism, unrealistic body image or abuse. While popular thought often dismisses eating disorders as a burden carried only by rich white teenage girls, research shows it’s rising among minority groups — both gay and straight — boys and men.
Rinaldis credits finding a spot at St. Paul’s Hospital and working with its then-head of the eating disorder program, Dr. Laird Birmingham, with saving her life. She was immediately given intravenous fluids to replenish missing nutrients. She ate small meals designed to ease her into eating again without triggering dangerous reactions associated with giving too much food to a starving person, including heart failure and seizure.
It ended years of bizarre rules that an inner voice had imposed on her since age 16: a strict schedule for any eating, a handful of acceptable foods, extreme exercise routines taking up to five hours a day, and no skin contact with forbidden foods like butter. She needed to wear a rubber glove to remove it from the fridge when setting the table for her Italian family.
Yet she kept up with other demands in her life — helping her ill mother, staying on the honour role, getting a scholarship to the University of British Columbia.
“It was my coping mechanism. The only thing I could control was anything that went into my mouth,” she recalls.
“I didn’t think I was going to potentially die on the stair climber. I felt great, but it was an illusion. I was completely disassociated from my body. I had lost all feeling of hunger.”
Looking back at her mental suffering, the physical damage (she had osteopenia — the first stages of osteoporosis — no periods for six years, her hair was falling out), and the sheer waste of human energy has driven Rinaldis to launch a not-for-profit organization to help other eating disorder sufferers get the treatment they need early on.
Project True has raised money from a small yet growing number of Vancouver groups and businesses to fund outpatient therapy for three people whose names will be drawn Feb. 6. She hopes more funders will step up to pay for other applicants who aren’t picked in the random draw. They’ll each get $2,000 worth of counselling at a private eating disorder clinic that opened last year, Dr. Birmingham and Associates. Birmingham estimates that a typical run of treatment — psychological therapy, advice from nutritionists — will run about $4,000 per person. Rinaldis says since leaving St. Paul’s she’s spent more than $55,000 to work with counsellors, nutritionists and personal trainers who have knowledge about eating disorders.
The only publicly funded treatments in B.C. are two in-hospital programs: St. Paul’s for adults and B.C. Children’s Hospital for patients up to age 18. A third option is the Looking Glass Residence in Vancouver — a program relocated from the former Woodstone Residence on Galiano Island — which has 14 publicly funded beds for B.C. residents.
Deborah Grimm, co-founder of the Looking Glass Foundation, says more people recognize anorexia, bulimia and binge eating as mental illnesses today, but that can be another reason for some to stay silent about the condition. Just as society used to blame sufferers for making themselves sick, talking about psychological problems runs up against its own set of taboos, she says.
“There’s so much stigma around eating disorders. There’s the historical level of blame, then there’s the new stigma of mental illness,” says Grimm.
“We’re starting to understand as a nation that mental health affects physical health. It’s starting to change, but only in infinitesimal amounts.”
As for Rinaldis, she’s now a fit-looking recreational hockey player with a beaming smile. She has high hopes that Project True and its website can be a clearing house for information about prevention and treatment for eating disorders.
And she can finally enjoy a good meal.
“People are often surprised at how much I eat these days. It’s not like I do not have some anxiety in certain situations and certain foods bring up memories, but I am able to work through all that.”
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A list of Metro Vancouver programs and organizations specializing in eating disorders:
• Provincial Specialized Eating Disorder Program at B.C. Children’s Hospital
• St. Paul’s Hospital Eating Disorders Program
• The Looking Glass Foundation and Looking Glass Residence
• Kelty Mental Health Resource Centre at B.C. Children’s Hospital
• Provincial Eating Disorder Awareness or PEDAW
• Jessie’s Legacy Eating Disorders Prevention Program
• Dr. Birmingham and Associates
• Vancouver Coastal Health Eating Disorders Program, locations in East Vancouver and Richmond
• Project True