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EF: Perhaps We Could start with the question of what made you interested in working with eating disorders in the first place?
JM: I've always had an interest in food, which came from my own background. My mother was a superb cook. We ate Italian style in my house and our food was different from that of my friends. The other reason I got into working with children and food was that I was working in a local child psychiatry unit, and they offered an inpatient, and an outpatient, service to children and adolescents suffering from anorexia nervosa.
EF: The difference between treating adults and treating children is, I imagine, partly about the difference in the physical effects of the illness. Many of the adults that I see have come to terms with having an eating disorder and structure their internal and external worlds so that they do survive, but only just, and those that do recover have very few long-term side effects, although bulimics can have long-term damage to their teeth and anorectics to their bones.
JM: Yes, that is true and certainly osteoporosis affects adults as a result of long-term chronic starvation. The fact that osteoporosis brings the risk of broken bones in your 60s and 70s, even when you just have a slight fall, is often forgotten about. I don't know so much about adult eating disorders. When I started working with eating-disordered adolescents they were different from adults in the sense that their bodies were growing and they should have been menstruating; they should have had growth spurts; and they should have been developing sexually. All of these developments were severely impaired, including their
desired normal height, which was often impaired for life as a result of long-term starvation.
EF: I, in turn, don't know very much about the side effects for children. Can fertility be impaired for life?
JM: It can be, but generally what happens is that normal sexual development, with the possibility of being fertile, comes back as weight is gained. F